Melissa De Mattos, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11566 Issued in OR

Practice address

13831 NW Cornell Rd Ste C
Portland, OR 97229-5465

Phone

(503) 718-3762

NPI assigned

Feb 8, 2022

Last updated

Feb 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Advantage Dental Group, PC

  dba Advantage Dental Oral Health Center

  • General Practice Dentistry
  • Bend, OR
  • NPI 1972970671
  NPD (past)

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1669126744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11470",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974403670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13831 NW CORNELL RD STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295465",
            "telephone_number": "503-718-3762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE MATTOS",
        "first_name": "MELISSA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11566",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore H. De Looze, MD
• John R. De Luca, B.PHARM
• Alexis B De Lucca, MD
• Carla De Martino, LMT
• Angelo Mario De Mattos, MD
• Alanna Nicole De Mello, MD
• Silvio Wanderley De Melo Jr., MD
• Jeffrey Steven De Mond, MD, MPH
• Michelle De Oliveira, OTD
• De Paul Drug and Alcohol Treatment Center

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.

Verify at the official NPI Registry.