Individual
DR. SEVERINO JOSE MATA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-2000
Mailing address
55 BRITTANY FARMS RD APT 213, NEW BRITAIN, CT 06053-1203
(860) 970-6580
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/13/2015
Last updated
07/13/2015
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