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NPI Code Detail

MEDICARE: MATTHEW MASTROROCCO DMD, PA

MEDICARE: MATTHEW MASTROROCCO DMD, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center3732SC

General Provider Information

NPI Number : 1114396629
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATTHEW MASTROROCCO DMD, PA
Provider Business Mailing Address
First Line : 4101 MAIN ST
Second Line : SUITE D
City : HILTON HEAD
State : SC
Zip : 29926-4608
Country : US
Telephone Number : 843-682-4601
Fax Number : 843-682-4602
Provider Business Practice Location Address
First Line : 4101 MAIN ST
Second Line : SUITE D
City : HILTON HEAD
State : SC
Zip : 29926-4608
Country : US
Telephone Number : 843-682-4601
Fax Number : 843-682-4602
Authorized Official
Title or Position : DENTIST
Name : DR. MATTHEW RYAN MASTROROCCO
Credential : DMD
Telephone Number : 843-682-4601
Provider Enumeration Date : 09/15/2015
Last Update Date : 09/15/2015

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Directions to “MATTHEW MASTROROCCO DMD, PA ” Practice Location

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