Provider Demographics
NPI:1851090187
Name:PAZIENZA, MATTHEW ANGELO (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANGELO
Last Name:PAZIENZA
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 1:266 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4524
Mailing Address - Country:US
Mailing Address - Phone:401-751-8046
Mailing Address - Fax:
Practice Address - Street 1:266 WAYLAND AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4524
Practice Address - Country:US
Practice Address - Phone:401-751-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN036121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice