Provider Demographics
NPI:1841387149
Name:ANTONIO J. MATTERO, D.D.S. INC.
Entity type:Organization
Organization Name:ANTONIO J. MATTERO, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-596-7734
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN014811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty