Provider Demographics
NPI:1508525148
Name:MATTHEW MASTROROCCO DMD, PA
Entity Type:Organization
Organization Name:MATTHEW MASTROROCCO DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-681-4601
Mailing Address - Street 1:4101 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4609
Mailing Address - Country:US
Mailing Address - Phone:843-682-4601
Mailing Address - Fax:843-682-4602
Practice Address - Street 1:25 SUMMIT DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4999
Practice Address - Country:US
Practice Address - Phone:843-706-3800
Practice Address - Fax:843-706-3802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEW MASTROROCCO DMD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty