Provider Demographics
NPI:1801970371
Name:PILOT, MATT A (DDS)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:A
Last Name:PILOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 119TH AVE SE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3799
Mailing Address - Country:US
Mailing Address - Phone:425-746-6554
Mailing Address - Fax:425-746-0145
Practice Address - Street 1:5611 119TH AVE SE
Practice Address - Street 2:SUITE #2
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3799
Practice Address - Country:US
Practice Address - Phone:425-746-6554
Practice Address - Fax:425-746-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice