Organization
ANTHONY G. DIMATTEO DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY G DIMATTEO DDS (PARTNER)
(508) 765-5985
Entity
Organization
Contact information
Practice address
914 MAIN STREET, SOUTHBRIDGE, MA 01550
(508) 765-5985
Mailing address
914 MAIN STREET, SOUTHBRIDGE, MA 01550
(508) 765-5985
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12696
MA
1223G0001X
General Practice Dentistry
12974
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000112
DELTA DENTAL
MA
05
—
0246409
—
MA
01
—
X10388DR
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/08/2007
Last updated
04/10/2012
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