Provider Demographics
NPI:1457577124
Name:MATZNER, DEBORAH FREDDA (DDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:FREDDA
Last Name:MATZNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELKLAND RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3302
Mailing Address - Country:US
Mailing Address - Phone:631-243-1438
Mailing Address - Fax:
Practice Address - Street 1:22 ELKLAND RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3302
Practice Address - Country:US
Practice Address - Phone:631-243-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0353641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice