Provider Demographics
NPI:1528284296
Name:EANNACCONE, MATTHEW (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:EANNACCONE
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 1:215 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4253
Mailing Address - Country:US
Mailing Address - Phone:631-427-8700
Mailing Address - Fax:631-692-5382
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6917
Practice Address - Country:US
Practice Address - Phone:631-427-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice