Provider Demographics
NPI:1659635175
Name:LALLI, MATTHEW FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FRANK
Last Name:LALLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3110 GRAND AVE COURTLAND SATORI
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:914-552-2281
Mailing Address - Fax:914-968-2474
Practice Address - Street 1:1721 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-294-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131731223S0112X
NY50-0586091223S0112X
NY0586091223S0112X
FLDN275951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery