Provider Demographics
NPI:1285817767
Name:PAUL F. DIMATTIA DDS
Entity type:Organization
Organization Name:PAUL F. DIMATTIA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DIMATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-862-0665
Mailing Address - Street 1:76 BEDFORD ST
Mailing Address - Street 2:CUSTANCE PLACE, UNIT 8
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:781-862-0665
Mailing Address - Fax:781-861-6628
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:CUSTANCE PLACE, UNIT 8
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-862-0665
Practice Address - Fax:781-861-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty