Active NPI
Matthew Del Mastro, DMD
- Endodontics
- Plymouth, MN
National Provider Identifier
1659607653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D12910
- Practice address
- 3401 Highway 169 N
Plymouth, MN 55441-2413 - Phone
- (763) 559-0859
- NPI assigned
- Oct 26, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN1855145 | MA | |
| Endodontics | 1223E0200X | D12910 | MN | Primary |
Addresses
Primary practice location
3401 Highway 169 N
Plymouth, MN 55441-2413
Mailing address
8052 Magnolia LN N
Maple Grove, MN 55369-7177
Phone (401) 258-2909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1855145 | MA | MD | Endodontist |
| D12910 | MN | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontic Professionals PA - St Anthony Endodontics | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- Minneapolis, MN
- NPI 1538577341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307232000000",
"number": "1659607653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8052 MAGNOLIA LN N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697177",
"telephone_number": "401-258-2909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 HIGHWAY 169 N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412413",
"telephone_number": "763-559-0859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEL MASTRO",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-26",
"last_updated": "2011-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MA",
"license": "DN1855145",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "D12910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.