Healthcare Provider Details

I. General information

NPI: 1205590510
Provider Name (Legal Business Name): SAL C ZAMMITTI DMD MMSC PLLC AND MATTHEW P GIDALY DDS PLLC V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 HYLAS LN STE B
HUNTERSVILLE NC
28078-9657
US

IV. Provider business mailing address

4605 HYLAS LN STE B
HUNTERSVILLE NC
28078-9657
US

V. Phone/Fax

Practice location:
  • Phone: 704-456-9166
  • Fax: 704-448-0954
Mailing address:
  • Phone: 704-456-9166
  • Fax: 704-448-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW PHILIP GIDALY
Title or Position: OWNER/PARTNER
Credential: DDS
Phone: 516-848-6762