Provider Demographics
NPI:1821196916
Name:MATTERO, ANTONIO JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:JOHN
Last Name:MATTERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2901
Mailing Address - Country:US
Mailing Address - Phone:401-596-7734
Mailing Address - Fax:401-596-7780
Practice Address - Street 1:31 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2901
Practice Address - Country:US
Practice Address - Phone:401-596-7734
Practice Address - Fax:401-596-7780
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN014811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice