Provider Demographics
NPI:1851423339
Name:SCAFFA, MATTHEW THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SCAFFA
Suffix:
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 1:112 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3017
Mailing Address - Country:US
Mailing Address - Phone:718-948-4393
Mailing Address - Fax:718-948-7636
Practice Address - Street 1:112 FOSTER RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3017
Practice Address - Country:US
Practice Address - Phone:718-948-4393
Practice Address - Fax:718-948-7636
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039411-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice