Provider Demographics
NPI:1831275130
Name:MATTIOLI, GREGORY FRANCIS (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:FRANCIS
Last Name:MATTIOLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2142
Mailing Address - Country:US
Mailing Address - Phone:724-224-4000
Mailing Address - Fax:724-224-1367
Practice Address - Street 1:1619 UNION AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2142
Practice Address - Country:US
Practice Address - Phone:724-224-4000
Practice Address - Fax:724-224-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025935L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice