MEDICARE: DR. MANUEL JOHN MATOS D.D.S.

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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22DI02076600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407859408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL JOHN MATOS D.D.S.

Provider Business Mailing Address
First Line	:	230 W JERSEY ST
Second Line	:	STE 302
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-1352
Country	:	US
Telephone Number	:	908-282-6998
Fax Number	:	908-282-0306

Provider Business Practice Location Address
First Line	:	230 W JERSEY ST
Second Line	:	STE 302
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-1352
Country	:	US
Telephone Number	:	908-282-6998
Fax Number	:	908-282-0306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/21/2013

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