Individual
DR. PETRO MATSYSHYN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
330 MAIN ST, HARTFORD, CT 06106-1860
(860) 899-2804
Mailing address
119 TOWNE ST, APT. 464, STAMFORD, CT 06902-5952
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02484400
NJ
1223G0001X
General Practice Dentistry
010721
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2011
Last updated
07/11/2012
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