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General NPI Number Information
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NPI Number | 1801050968
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Entity Type | Organization
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Legal Business Name | CHARLES K. DEMATTE DDS INC
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 334 MAIN ST
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1346
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Country | US
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Telephone | 740-635-2567
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Fax | 740-635-1976
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Provider Business Mailing Address
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Address Line | 334 MAIN ST
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1346
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Country | US
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Telephone | 740-635-2567
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Fax | 740-635-1976
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES KENNETH DEMATTE JR.
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Credential | DDS
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Telephone | 740-635-2567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15334
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License Number State | OH
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