Provider Demographics
NPI:1255567483
Name:MATARIA, AHMED (DDS PC)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:MATARIA
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2504
Mailing Address - Country:US
Mailing Address - Phone:773-429-1400
Mailing Address - Fax:773-429-1410
Practice Address - Street 1:4934 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:773-429-1400
Practice Address - Fax:773-429-1410
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100937122300000X
IL019027955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist