Provider Demographics
NPI:1407040637
Name:MATARAZZO, STEPHEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MATARAZZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CROWN COLONY DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0904
Mailing Address - Country:US
Mailing Address - Phone:617-471-8882
Mailing Address - Fax:617-472-3929
Practice Address - Street 1:300 CROWN COLONY DR
Practice Address - Street 2:SUITE 109
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0904
Practice Address - Country:US
Practice Address - Phone:617-471-8882
Practice Address - Fax:617-472-3929
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist