Provider Demographics
NPI:1205416625
Name:MATRO, PRISCO HALILI (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:PRISCO
Middle Name:HALILI
Last Name:MATRO
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 NE BIG BERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3510
Mailing Address - Country:US
Mailing Address - Phone:360-969-6636
Mailing Address - Fax:
Practice Address - Street 1:1339 NE BIG BERRY LOOP
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3510
Practice Address - Country:US
Practice Address - Phone:360-969-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH28287124Q00000X
124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist