Provider Demographics
NPI:1699182196
Name:MATILSKY, JEFF (DMD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MATILSKY
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 1:2251 NW 41ST ST STE 40
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6668
Mailing Address - Country:US
Mailing Address - Phone:352-376-4637
Mailing Address - Fax:
Practice Address - Street 1:2251 NW 41ST ST STE 40
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6668
Practice Address - Country:US
Practice Address - Phone:352-376-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist