Provider Demographics
NPI:1386766749
Name:MATUSZAK, TIMOTHY ERNEST (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ERNEST
Last Name:MATUSZAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1829
Mailing Address - Country:US
Mailing Address - Phone:412-488-7750
Mailing Address - Fax:
Practice Address - Street 1:123 S 18TH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1829
Practice Address - Country:US
Practice Address - Phone:412-488-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020730-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice