MEDICARE: DR. RAJENDAR MATTA D.M.D

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	122300000X	Dentist	DN1855225	MA
2	122300000X	Dentist	DS040531	PA

General Provider Information

NPI Number	:	1780814954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJENDAR MATTA D.M.D

Provider Business Mailing Address
First Line	:	7409 UNIVERSITY BLVD
Second Line	:	APT # D
City	:	CORAOPOLIS
State	:	PA
Zip	:	15108-2592
Country	:	US
Telephone Number	:	205-617-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	7409 UNIVERSITY BLVD
Second Line	:
City	:	CORAOPOLIS
State	:	PA
Zip	:	15108-2592
Country	:	US
Telephone Number	:	205-617-7417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	01/11/2016

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