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NPI Code Detail

MEDICARE: DR. THOMAS SCOTT MATTEUCCI DDS

MEDICARE: DR. THOMAS SCOTT MATTEUCCI DDS
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
1122300000XDentist2334NV

General Provider Information

NPI Number : 1235147695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS SCOTT MATTEUCCI DDS
Provider Business Mailing Address
First Line : 2600 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-4006
Country : US
Telephone Number : 702-365-6499
Fax Number : 702-221-8465
Provider Business Practice Location Address
First Line : 2600 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-4006
Country : US
Telephone Number : 702-365-6499
Fax Number : 702-221-8465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/08/2007

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