Doctor Name: | ANDREA M MATTIA |
NPI Number: | 1669547790 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.D.S. |
License Number: | 22DI02135500 |
Business Practice Address: | 175 Old Tappan Rd Old Tappan, NJ - 076757042 |
Business Phone Number: | 2017687100 |
Business Fax Number: | 2017680183 |
Mailing Address: | 175 Old Tappan Rd, OLD TAPPAN |
State: | NJ |
Postal Code: | 076757042 |
Phone Number: | 2017687100 |
Fax Number: | 2017680183 |
NPI Enumeration Date: | 11/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 22DI02135500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |