Provider Demographics
NPI:1780301465
Name:MATIAS DENTAL GROUP LLC
Entity type:Organization
Organization Name:MATIAS DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-483-8486
Mailing Address - Street 1:5247 WISCONSIN AVE NW STE 3A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2059
Mailing Address - Country:US
Mailing Address - Phone:202-362-7418
Mailing Address - Fax:202-362-7410
Practice Address - Street 1:5247 WISCONSIN AVE NW STE 3A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2059
Practice Address - Country:US
Practice Address - Phone:202-362-7418
Practice Address - Fax:202-362-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty