Healthcare Provider Details

I. General information

NPI: 1609492537
Provider Name (Legal Business Name): ANTHONY MICHAEL MATTEOTTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DELAFIELD RD
PITTSBURGH PA
15240-1005
US

IV. Provider business mailing address

115 EMERSON AVE APT #5
PITTSBURGH PA
15215
US

V. Phone/Fax

Practice location:
  • Phone: 412-360-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042730
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: