Provider Demographics
NPI:1821770439
Name:OLIVEIRA MATOS, ADAIAS (DDS)
Entity type:Individual
Prefix:
First Name:ADAIAS
Middle Name:
Last Name:OLIVEIRA MATOS
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 1:1155 MAIN ST APT 205
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2381
Mailing Address - Country:US
Mailing Address - Phone:313-650-8288
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST # 222E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3099
Practice Address - Country:US
Practice Address - Phone:716-829-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000154-01122300000X
MI2952000787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist