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General NPI Number Information
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NPI Number | 1043951809
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Entity Type | Individual
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Provider Name | MICHAELA ROSE MATOS DMD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 08/04/2024
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Provider Practice Location Address
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Address Line | 65 LOCUST AVE STE 10
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City | NEW CANAAN
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State | CT
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Zip | 06840-4753
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Country | US
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Telephone | 203-594-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 220 STONEFENCE RD
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City | NAUGATUCK
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State | CT
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Zip | 06770-1552
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Country | US
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Telephone | 203-690-6396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13698
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License Number State | CT
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