Provider Demographics
NPI:1649612532
Name:MATTURRO DENTAL PC
Entity type:Organization
Organization Name:MATTURRO DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTURRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-735-7444
Mailing Address - Street 1:3601 HEMPSTEAD TPKE
Mailing Address - Street 2:422
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1375
Mailing Address - Country:US
Mailing Address - Phone:516-735-7444
Mailing Address - Fax:516-735-7516
Practice Address - Street 1:3601 HEMPSTEAD TPKE
Practice Address - Street 2:422
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1375
Practice Address - Country:US
Practice Address - Phone:516-735-7444
Practice Address - Fax:516-735-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty