Provider Demographics
NPI:1376691378
Name:DEMATTEO, BRIAN J (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:DEMATTEO
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 1:3830 STARRS CENTRE DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-8699
Mailing Address - Fax:
Practice Address - Street 1:3830 STARRS CENTRE DR
Practice Address - Street 2:SUITE #2
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8003
Practice Address - Country:US
Practice Address - Phone:330-533-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH195551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice