Provider Demographics
NPI:1285749820
Name:MATCZAK, EWA G (DMD)
Entity type:Individual
Prefix:MRS
First Name:EWA
Middle Name:G
Last Name:MATCZAK
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 1:3084 ARAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4316
Mailing Address - Country:US
Mailing Address - Phone:215-739-2787
Mailing Address - Fax:215-739-4113
Practice Address - Street 1:3084 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4316
Practice Address - Country:US
Practice Address - Phone:215-739-2787
Practice Address - Fax:215-739-4113
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027415L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist