Organization
CHARLES K. DEMATTE DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES KENNETH DEMATTE JR. DDS (OWNER)
(740) 635-2567
Entity
Organization
Contact information
Practice address
334 MAIN ST, BRIDGEPORT, OH 43912-1346
(740) 635-2567
(740) 635-1976
Mailing address
334 MAIN ST, BRIDGEPORT, OH 43912-1346
(740) 635-2567
(740) 635-1976
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15334
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0604019
—
OH
Enumeration date
07/17/2008
Last updated
07/17/2008
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