Provider Demographics
NPI:1982605176
Name:MATIC, LORETTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:MATIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PARAGON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3702
Mailing Address - Country:US
Mailing Address - Phone:615-834-9667
Mailing Address - Fax:615-834-9668
Practice Address - Street 1:534 PARAGON MILLS RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3702
Practice Address - Country:US
Practice Address - Phone:615-834-9667
Practice Address - Fax:615-834-9668
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist