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General NPI Number Information
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NPI Number | 1629359781
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Entity Type | Individual
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Provider Name | PROSPERO EMANUEL MATOS DDS
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Gender | Male
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 5129 N GARLAND AVE SUITE 700
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City | GARLAND
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State | TX
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Zip | 75040-2725
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Country | US
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Telephone | 972-276-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 5129 N GARLAND AVE SUITE 700
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City | GARLAND
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State | TX
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Zip | 75040-2725
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Country | US
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Telephone | 972-276-5191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI02481300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28482
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License Number State | TX
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