Provider Demographics
NPI:1255401840
Name:MATOS, JORGE A (DDS, CAGS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:MATOS
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WESTFIELD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1658
Mailing Address - Country:US
Mailing Address - Phone:908-354-4428
Mailing Address - Fax:
Practice Address - Street 1:520 WESTFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1658
Practice Address - Country:US
Practice Address - Phone:908-354-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI206701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics