Teny Matavoosi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032227 Issued in IL

Practice address

7110 W Archer Ave
Chicago, IL 60638-2204

Phone

(773) 432-4744

NPI assigned

Jun 28, 2019

Sex

Female

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

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561680000000",
    "number": "1528629656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 S MAPLE AVE APT 3B",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603023430",
            "telephone_number": "818-731-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7110 W ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382204",
            "telephone_number": "773-432-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAVOOSI",
        "first_name": "TENY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ralph Matar, M.D
• Karah Marie Matarazzo, LCSW
• Ameer Matariyeh
• Sophia Sami Matariyeh, PHARMD
• Sarah Nikolai Matatov
• Leslie Mataya, M.D.
• Sarah Deanne Matchen, LCSW
• Tracy L Matchinski, OD
• Neneyo Emmanuel Mate-Kole, MD
• Haneefa Mateen, PSYD

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; 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.