Ralph Anthony Matacale, D.D.S.
Individual provider Active NPI Dentist · Morganfield, KY
NPI 1720041353 · NPPES record last updated Aug 8, 2012
Key facts
- NPI
- 1720041353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6665 (KY)
- Practice address
- 2302 U.S. Highway 60 East
Earl C Clement Job Corps Academy
Morganfield, KY 42437 - Phone
- (270) 389-5651
- Fax
- (270) 389-5303
- NPI assigned
- Apr 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009711 | IN | MD | Dentist |
| 6665 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12009711 | IN | |
| Dentist | 122300000X | 6665 | KY | Yes |
Addresses
Primary practice location
2302 U.S. Highway 60 East
Earl C Clement Job Corps Academy
Morganfield, KY 42437
Mailing address
6602 Little Schaefer Rd
Evansville, IN 47720-8191
Phone (812) 421-1315
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200262160B | Medicaid | IN |
Other providers in Morganfield, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.