Provider Demographics
NPI:1679725758
Name:MATALONI, PETER A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MATALONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 E DRINKER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2541
Mailing Address - Country:US
Mailing Address - Phone:570-342-6801
Mailing Address - Fax:570-342-0442
Practice Address - Street 1:768 E DRINKER ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2541
Practice Address - Country:US
Practice Address - Phone:570-342-6801
Practice Address - Fax:570-342-0442
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02530-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice