Healthcare Provider Details

I. General information

NPI: 1720143902
Provider Name (Legal Business Name): DANIEL JOHN MATURO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6739 PERSHING RD
STICKNEY IL
60402-4098
US

IV. Provider business mailing address

6739 PERSHING RD
STICKNEY IL
60402-4098
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-3770
  • Fax: 708-484-6345
Mailing address:
  • Phone: 708-749-3770
  • Fax: 708-484-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: