Provider Demographics
NPI:1275733149
Name:MATUTE, VICTOR ANDRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANDRES
Last Name:MATUTE
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 1:6685 FOREST HILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3356
Mailing Address - Country:US
Mailing Address - Phone:561-568-6112
Mailing Address - Fax:305-985-5246
Practice Address - Street 1:6685 FOREST HILL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3356
Practice Address - Country:US
Practice Address - Phone:561-568-6112
Practice Address - Fax:305-985-5246
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL128421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice