Provider Demographics
NPI:1003173386
Name:MATTOS, KATIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATIA
Middle Name:
Last Name:MATTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 BRICKELL AVE UNIT 4201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3790
Mailing Address - Country:US
Mailing Address - Phone:786-208-2820
Mailing Address - Fax:
Practice Address - Street 1:2905 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4212
Practice Address - Country:US
Practice Address - Phone:954-392-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306121223E0200X
FLDN195921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics