Provider Demographics
NPI:1033212451
Name:JEFF R MATILSKY DMD PA
Entity Type:Organization
Organization Name:JEFF R MATILSKY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATILSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-376-4637
Mailing Address - Street 1:1110 NW 8TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4969
Mailing Address - Country:US
Mailing Address - Phone:352-376-4637
Mailing Address - Fax:352-373-2268
Practice Address - Street 1:1110 NW 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4969
Practice Address - Country:US
Practice Address - Phone:352-376-4637
Practice Address - Fax:352-373-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty