Provider Demographics
NPI:1679919864
Name:MATTHES, JOHN JAMES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:MATTHES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2501
Mailing Address - Country:US
Mailing Address - Phone:212-228-1600
Mailing Address - Fax:212-228-5600
Practice Address - Street 1:191 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2501
Practice Address - Country:US
Practice Address - Phone:212-228-1600
Practice Address - Fax:212-228-5600
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0576041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice