MEDICARE: THOMAS S MATTEUCCI DDS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114679750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS S MATTEUCCI DDS LTD

Provider Business Mailing Address
First Line	:	2764 LAKE SAHARA DR STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3400
Country	:	US
Telephone Number	:	702-365-6499
Fax Number	:	702-221-8465

Provider Business Practice Location Address
First Line	:	2764 LAKE SAHARA DR STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3400
Country	:	US
Telephone Number	:	702-365-6499
Fax Number	:	702-221-8465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW MATTEUCCI
Credential	:	DMD
Telephone Number	:	702-365-6499

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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