Matthew Kimball Black, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

61025296 Issued in WA

Practice address

512 N Young St
Kennewick, WA 99336-7839

Phone

(509) 783-7600

Fax

(509) 783-0774

NPI assigned

May 18, 2015

Sex

Male

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 20, 2020 through Jan 20, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Todd Cooper, DDS, Tyson Teeples, DMD, MD, Ryan Toponce, DMD, PS.

  • Oral and Maxillofacial Surgery (Dentist)
  • Kennewick, WA
  • NPI 1487728614
  NPD
• J.R. Haynie DDS PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Coeur D Alene, ID
  • NPI 1548607633
  NPD (past)
• Marston T Westbrook , DDS, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Coeur D Alene, ID
  • NPI 1114161551
  NPD (past)

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1891173282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 N YOUNG ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367839",
            "telephone_number": "509-783-7600",
            "fax_number": "509-783-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 N YOUNG ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367839",
            "telephone_number": "509-783-7600",
            "fax_number": "509-783-0774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 N Stonewall Ave",
            "address_2": "Suite #206",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731171214",
            "country_code": "US",
            "telephone_number": "405-271-4441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "476394 US-95",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Ponderay",
            "state": "ID",
            "postal_code": "83852",
            "country_code": "US",
            "telephone_number": "208-664-0844",
            "fax_number": "208-664-9682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MATTHEW",
        "middle_name": "KIMBALL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-18",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "61025296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Bishop
• Andreas Joseph Bitterlich, PA-C
• Blake Bitton, PA-C, PHD, RDH
• Erica Bjella
• Black & Salesky D.D.S., P.S.
• Sydney Blackman
• Lindsay Renee Blair, LMT
• Lois M Blair, CRNA
• Makayla Ann Blair
• Hayden Blanchard, PA-C

• Oral and Maxillofacial Surgery (Dentist) in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.