Healthcare Provider Details

I. General information

NPI: 1114132552
Provider Name (Legal Business Name): FRANK JOSEPH MASTALERZ JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DREAM DENTAL 323 E. OAK ST.
OAKLAND MD
21550
US

IV. Provider business mailing address

2432 E. ALPINE DR.
TERRA ALTA WV
26764
US

V. Phone/Fax

Practice location:
  • Phone: 310-334-3435
  • Fax:
Mailing address:
  • Phone: 443-605-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6913
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2729
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6913
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2729
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: