Provider Demographics
NPI:1083458293
Name:ABBATEMATTEO, KAITRIA BRIELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:KAITRIA
Middle Name:BRIELLE
Last Name:ABBATEMATTEO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 SW ARCHER RD APT 1003
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1008
Mailing Address - Country:US
Mailing Address - Phone:941-204-1486
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D1-40
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist