Blake T.K. Matsuura, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DT-2446 Issued in HI

Practice address

98-1256 Kaahumanu St Ste E303
Pearl City, HI 96782-3282

Phone

(808) 488-1988

NPI assigned

Jul 21, 2011

Last updated

Mar 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aiea Pearl City Dental Care LLP

  • Dental Clinic/Center
  • Pearl City, HI
  • NPI 1538810262
  NPD Authorized official
• Dreamtect Dental LLC

  • General Practice Dentistry
  • Pearl City, HI
  • NPI 1043848922
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585267200000",
    "number": "1487942678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-1256 KAAHUMANU ST STE E303",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "967823282",
            "telephone_number": "808-488-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-1256 KAAHUMANU ST STE E303",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "967823282",
            "telephone_number": "808-488-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUURA",
        "first_name": "BLAKE",
        "middle_name": "T.K.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "DT-2446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Y Mamalias, CHS
• Tiffani Mamuad
• Jhoana Maristela
• Enrique Martino
• Dasmier Lashay Mason
• Melissa Ann Matutino, LMT
• Crystal McCormick
• Megan McInnis
• Deann McKnight
• Roberta Ann Medeiros

• General Practice Dentistry in Pearl City, HI
• Providers in Pearl City, HI by specialty
• General Practice Dentistry in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.