Provider Demographics
NPI:1134251465
Name:STEPHEN J. MATARAZZO, D.M.D, PC
Entity type:Organization
Organization Name:STEPHEN J. MATARAZZO, D.M.D, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATARAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-471-8882
Mailing Address - Street 1:300 CROWN COLONY DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0904
Mailing Address - Country:US
Mailing Address - Phone:617-471-8882
Mailing Address - Fax:617-472-3929
Practice Address - Street 1:300 CROWN COLONY DR
Practice Address - Street 2:SUITE 109
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0904
Practice Address - Country:US
Practice Address - Phone:617-471-8882
Practice Address - Fax:617-472-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty