Provider Demographics
NPI:1093782476
Name:DELESSIO-MATTA, ANNMARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:
Last Name:DELESSIO-MATTA
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 1:1 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2295
Mailing Address - Country:US
Mailing Address - Phone:203-264-1497
Mailing Address - Fax:203-264-4039
Practice Address - Street 1:1 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 206
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2295
Practice Address - Country:US
Practice Address - Phone:203-264-1497
Practice Address - Fax:203-264-4039
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry