Active NPI
Matthew David King, DDS
- Dentist
- Seneca, SC
National Provider Identifier
1508423732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9585
- Practice address
- 210 S Oak St
Seneca, SC 29678-3416 - Phone
- (864) 614-5990
- NPI assigned
- May 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9585 | SC | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
210 S Oak St
Seneca, SC 29678-3416
Mailing address
210 S Oak St
Seneca, SC 29678-3416
Phone (864) 614-5990
Other practice location 1
506 Lenox Ave
New York, NY 10037-1802
Phone (212) 939-2399
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210726001968 | PA | Order and Referring Only - Oral Surgery | 6406259670 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9585 | SC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596585600000",
"number": "1508423732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S OAK ST",
"city": "SENECA",
"state": "SC",
"postal_code": "296783416",
"telephone_number": "864-614-5990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S OAK ST",
"city": "SENECA",
"state": "SC",
"postal_code": "296783416",
"telephone_number": "864-614-5990"
}
],
"practiceLocations": [
{
"address_1": "506 Lenox Ave",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100371802",
"country_code": "US",
"telephone_number": "212-939-2399",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KING",
"first_name": "MATTHEW",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-22",
"last_updated": "2020-08-05",
"certification_date": "2020-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "9585",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Seneca, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.