Provider Demographics
NPI:1477864916
Name:MATABAR, ENRIQUE A (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:A
Last Name:MATABAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:A
Other - Last Name:MATABAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:65 MICHIGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1011
Mailing Address - Country:US
Mailing Address - Phone:202-483-0082
Mailing Address - Fax:202-319-2832
Practice Address - Street 1:65 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1011
Practice Address - Country:US
Practice Address - Phone:202-483-0082
Practice Address - Fax:202-319-2832
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10007131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice