Healthcare Provider Details

I. General information

NPI: 1275597403
Provider Name (Legal Business Name): DENNIS ANTHONY DIMATTEO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TAUNTON AVE
EAST PROVIDENCE RI
02914-3731
US

IV. Provider business mailing address

8 GREENBRIER DR
BARRINGTON RI
02806-3818
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-8090
  • Fax: 401-435-5069
Mailing address:
  • Phone: 401-245-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM0198
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: