Active NPI
Matthew Roberto Pischek
- General Practice Dentistry
- Magnolia Springs, AL
National Provider Identifier
1861985483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6544
- Practice address
- 12440 Magnolia Ave Ste 200
Magnolia Springs, AL 36555-6434 - Phone
- (251) 965-1773
- NPI assigned
- Jun 8, 2018
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 6544 | AL | Primary |
Addresses
Primary practice location
12440 Magnolia Ave Ste 200
Magnolia Springs, AL 36555-6434
Mailing address
PO Box 545
Silverhill, AL 36576-0545
Phone (251) 213-1101
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 |
|---|---|---|---|
| 6544 | AL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magnolia Springs Dental, LLC | Current | Accepting new patients |
Locations
12440 Magnolia Ave
Ste 200
Magnolia Springs, AL 36555
Phone (251) 263-4991
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.
-
- Dental Clinic/Center
- Magnolia Springs, AL
- NPI 1295457901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658188800000",
"number": "1861985483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 545",
"city": "SILVERHILL",
"state": "AL",
"postal_code": "365760545",
"telephone_number": "251-213-1101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12440 MAGNOLIA AVE STE 200",
"city": "MAGNOLIA SPRINGS",
"state": "AL",
"postal_code": "365556434",
"telephone_number": "251-965-1773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PISCHEK",
"first_name": "MATTHEW",
"middle_name": "ROBERTO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-08",
"last_updated": "2022-07-19",
"certification_date": "2022-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "6544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magnolia Springs, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.