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General NPI Number Information
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NPI Number | 1821770439
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Entity Type | Individual
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Provider Name | ADAIAS OLIVEIRA MATOS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3435 MAIN ST # 222E
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City | BUFFALO
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State | NY
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Zip | 14214-3099
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Country | US
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Telephone | 716-829-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 MAIN ST APT 205
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City | BUFFALO
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State | NY
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Zip | 14209-2381
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Country | US
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Telephone | 313-650-8288
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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 | 000154-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2952000787
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License Number State | MI
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