Provider Demographics
NPI:1013914696
Name:DEFELICE, MATTHEW ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5315 E HIGH ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5438
Mailing Address - Country:US
Mailing Address - Phone:480-563-3960
Mailing Address - Fax:
Practice Address - Street 1:5315 E HIGH ST
Practice Address - Street 2:SUITE 119
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5438
Practice Address - Country:US
Practice Address - Phone:480-563-3960
Practice Address - Fax:480-563-3965
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ51961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery