Provider Demographics
NPI:1639242142
Name:MATLICK, AIMEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:MATLICK
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 1:209 SOUTH LIVINGSTON AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-994-1333
Mailing Address - Fax:973-994-2588
Practice Address - Street 1:209 SOUTH LIVINGSTON AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-994-1333
Practice Address - Fax:973-994-2588
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist