Provider Demographics
NPI:1750583514
Name:DEMATTEIS, JON MICHAEL JR
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:MICHAEL
Last Name:DEMATTEIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JON
Other - Middle Name:MICHAEL
Other - Last Name:DEMATTEIS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1 NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1511
Mailing Address - Country:US
Mailing Address - Phone:914-235-2227
Mailing Address - Fax:914-235-1126
Practice Address - Street 1:1 NORTHWOOD CIR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-1511
Practice Address - Country:US
Practice Address - Phone:914-235-2227
Practice Address - Fax:914-235-1126
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics