Provider Demographics
NPI:1598983926
Name:DIMATTIA, STEPHANIE NOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NOE
Last Name:DIMATTIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MINNESOTA PARK RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6125
Mailing Address - Country:US
Mailing Address - Phone:985-542-3368
Mailing Address - Fax:985-543-3335
Practice Address - Street 1:212 W MINNESOTA PARK RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6125
Practice Address - Country:US
Practice Address - Phone:985-542-3368
Practice Address - Fax:985-543-3335
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1852007Medicaid