Provider Demographics
NPI:1912440405
Name:FRANCIS S MATARAZZO DDS PC
Entity Type:Organization
Organization Name:FRANCIS S MATARAZZO DDS PC
Other - Org Name:MATARAZZO & MILICI GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATARAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-389-3161
Mailing Address - Street 1:1 CRESCENT DR
Mailing Address - Street 2:STE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1015
Mailing Address - Country:US
Mailing Address - Phone:215-389-3161
Mailing Address - Fax:215-389-1036
Practice Address - Street 1:1 CRESCENT DR
Practice Address - Street 2:STE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1015
Practice Address - Country:US
Practice Address - Phone:215-389-3161
Practice Address - Fax:215-389-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017265L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty