Healthcare Provider Details

I. General information

NPI: 1467273110
Provider Name (Legal Business Name): STEFANOS MATTHAIOS DDS, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 CHESTER AVE APT 609
CLEVELAND OH
44106-1637
US

IV. Provider business mailing address

10001 CHESTER AVE APT 609
CLEVELAND OH
44106-1637
US

V. Phone/Fax

Practice location:
  • Phone: 216-333-6875
  • Fax:
Mailing address:
  • Phone: 216-333-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberRES.004425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: