Provider Demographics
NPI:1598800369
Name:MATTA, ANDREW SHOUKRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SHOUKRY
Last Name:MATTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2623 WILMINGTON ROAD
Mailing Address - Street 2:NESHANNOCK PROFESSIONAL BUILDING
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:724-658-0822
Mailing Address - Fax:724-657-0884
Practice Address - Street 1:2623 WILMINGTON RD
Practice Address - Street 2:NESHANNOCK PROFESSIONAL BUILDING
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1529
Practice Address - Country:US
Practice Address - Phone:724-658-0822
Practice Address - Fax:724-657-0884
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0362531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice