Southlake Dental Corp
NPI 1154544740ActiveOrganization· Dentist, Periodontics· Fort Worth, TX
Dentist, Periodontics in Fort Worth, Texas, registered in NPPES in April 2007. The authorized official on file is Dwain Edwin Matelski, President.
Overview
| NPI | 1154544740 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 11, 2007 |
| Last updated in NPPES | Aug 22, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Periodontics Primary | 1223P0300X | 9930 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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