Provider Demographics
NPI:1932895497
Name:MATAM, JOSHUA MATHEW (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MATHEW
Last Name:MATAM
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 1:20 CHALMERS AVE
Mailing Address - Street 2:
Mailing Address - City:TOWN OF TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2603
Mailing Address - Country:US
Mailing Address - Phone:786-387-7063
Mailing Address - Fax:
Practice Address - Street 1:20 CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:TOWN OF TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-2603
Practice Address - Country:US
Practice Address - Phone:786-387-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program