Provider Demographics
NPI:1033107206
Name:MATTE, JOHN JERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JERALD
Last Name:MATTE
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 1:637 SAN MATEO BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3648
Mailing Address - Country:US
Mailing Address - Phone:505-255-7891
Mailing Address - Fax:505-255-4947
Practice Address - Street 1:637 SAN MATEO BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3648
Practice Address - Country:US
Practice Address - Phone:505-255-7891
Practice Address - Fax:505-255-4947
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice