Provider Demographics
NPI:1669547790
Name:MATTIA, ANDREA M (DDS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MATTIA
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 1:175 OLD TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7042
Mailing Address - Country:US
Mailing Address - Phone:201-768-7100
Mailing Address - Fax:201-768-0183
Practice Address - Street 1:175 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7042
Practice Address - Country:US
Practice Address - Phone:201-768-7100
Practice Address - Fax:201-768-0183
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021355001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry