Provider Demographics
NPI:1962405944
Name:MATT, JERALD S (DMD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:S
Last Name:MATT
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 1:776 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3411
Mailing Address - Country:US
Mailing Address - Phone:610-525-3933
Mailing Address - Fax:610-525-1512
Practice Address - Street 1:776 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3411
Practice Address - Country:US
Practice Address - Phone:610-525-3933
Practice Address - Fax:610-525-1512
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026387L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice