Provider Demographics
NPI:1699894576
Name:MATURO, RAYMOND ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:MATURO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6962
Mailing Address - Country:US
Mailing Address - Phone:734-663-2490
Mailing Address - Fax:734-663-5137
Practice Address - Street 1:2074 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6962
Practice Address - Country:US
Practice Address - Phone:734-663-2490
Practice Address - Fax:734-663-5137
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010132231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry