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General NPI Number Information
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NPI Number | 1780067322
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Entity Type | Individual
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Provider Name | CHARLES MATARAZZO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 111 BLOOMFIELD AVE
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City | DENVILLE
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State | NJ
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Zip | 07834-2701
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Country | US
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Telephone | 201-953-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 27 KANOUSE LN
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City | MONTVILLE
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State | NJ
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Zip | 07045-9535
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02604500
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License Number State | NJ
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