Healthcare Provider Details

I. General information

NPI: 1912440405
Provider Name (Legal Business Name): FRANCIS S MATARAZZO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRESCENT DR STE 300
PHILADELPHIA PA
19112-1015
US

IV. Provider business mailing address

1 CRESCENT DR STE 300
PHILADELPHIA PA
19112-1015
US

V. Phone/Fax

Practice location:
  • Phone: 215-389-3161
  • Fax: 215-389-1036
Mailing address:
  • Phone: 215-389-3161
  • Fax: 215-389-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS017265L
License Number StatePA

VIII. Authorized Official

Name: DR. FRANCIS S MATARAZZO
Title or Position: OWNER
Credential: DDS
Phone: 215-389-3161