MEDICARE: MATT A PILOT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6495	WA

General Provider Information

NPI Number	:	1801970371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT A PILOT DDS

Provider Business Mailing Address
First Line	:	5611 119TH AVE SE
Second Line	:	SUITE #2
City	:	BELLEVUE
State	:	WA
Zip	:	98006-3799
Country	:	US
Telephone Number	:	425-746-6554
Fax Number	:	425-746-0145

Provider Business Practice Location Address
First Line	:	5611 119TH AVE SE
Second Line	:	SUITE #2
City	:	BELLEVUE
State	:	WA
Zip	:	98006-3799
Country	:	US
Telephone Number	:	425-746-6554
Fax Number	:	425-746-0145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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