| Organization Name: | J A MASTROMATTEO DDS PLLC |
| NPI Number: | 1295075034 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH ANTHONY MASTROMATTEO (PRESIDENT) |
| Mailing Address: | 312 S Broadway St Lake Orion |
| State: | MI US |
| Postal Code: | 483622794 |
| Phone Number: | 2486931331 |
| Fax Number: | 2486931385 |
| NPI Enumeration Date: | 02/14/2013 |
| NPI Last Update Date: | 10/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | JM008259 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |