Provider Demographics
NPI:1891045944
Name:MASTROTA, DAVID E (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:MASTROTA
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 1:2215 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2443
Mailing Address - Country:US
Mailing Address - Phone:302-654-0100
Mailing Address - Fax:302-656-3235
Practice Address - Street 1:2215 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2443
Practice Address - Country:US
Practice Address - Phone:302-654-0100
Practice Address - Fax:302-656-3235
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist