Healthcare Provider Details

I. General information

NPI: 1780301465
Provider Name (Legal Business Name): MATIAS DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW STE 3A
WASHINGTON DC
20015-2059
US

IV. Provider business mailing address

5247 WISCONSIN AVE NW STE 3A
WASHINGTON DC
20015-2059
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-7418
  • Fax: 202-362-7410
Mailing address:
  • Phone: 202-362-7418
  • Fax: 202-362-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. THIAGO MATIAS
Title or Position: OWNER
Credential: DDS
Phone: 240-483-8486