Healthcare Provider Details

I. General information

NPI: 1205188547
Provider Name (Legal Business Name): SCOTT MATEER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CLARK AVE
MASSAPEQUA NY
11758-4950
US

IV. Provider business mailing address

70 CLARK AVE
MASSAPEQUA NY
11758-4921
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-9396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number054930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: