Individual
JOAO VICTOR DE OLIVEIRA MATIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7777 N WICKHAM RD STE 4, MELBOURNE, FL 32940-7978
(321) 255-6303
Mailing address
4301 COLUMBIA PIKE APT 531, ARLINGTON, VA 22204-5911
(301) 785-5335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401415860
VA
1223G0001X
General Practice Dentistry
Primary
DN24641
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401415860
VA DENTAL LICENSE
VA
01
—
DN24641
FL DENTAL LICENSE
FL
Enumeration date
07/26/2016
Last updated
06/12/2020
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