Healthcare Provider Details

I. General information

NPI: 1861607335
Provider Name (Legal Business Name): JOHN HILL MATTOCKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 CAMERON CT SUITE 408
SILVER SPRING MD
20910-4114
US

IV. Provider business mailing address

8830 CAMERON CT SUITE 408
SILVER SPRING MD
20910-4114
US

V. Phone/Fax

Practice location:
  • Phone: 301-587-2333
  • Fax:
Mailing address:
  • Phone: 301-587-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberMD 5261
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: