Provider Demographics
NPI:1912985011
Name:MATSKO, JOSEPH E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:MATSKO
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 1:3450 FORESTDALE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9142
Mailing Address - Country:US
Mailing Address - Phone:336-226-7115
Mailing Address - Fax:336-570-1434
Practice Address - Street 1:3450 FORESTDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9142
Practice Address - Country:US
Practice Address - Phone:336-226-7115
Practice Address - Fax:336-570-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1433412OtherUNITED CONCORDIA
NC902N6OtherBLUE CROSS BLUE SHIELD
NC89902N6Medicaid
NC89902N6Medicaid