Provider Demographics
NPI:1568511418
Name:MATTHEW J DENTES, D.D.S., P.C.
Entity Type:Organization
Organization Name:MATTHEW J DENTES, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DENTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-753-7107
Mailing Address - Street 1:193 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3312
Mailing Address - Country:US
Mailing Address - Phone:607-753-7107
Mailing Address - Fax:607-753-7091
Practice Address - Street 1:193 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3312
Practice Address - Country:US
Practice Address - Phone:607-753-7107
Practice Address - Fax:607-753-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0486341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty