Andrew S Matta DMD Boardman LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS036253 Issued in PA

Legal business name

ANDREW S MATTA DMD BOARDMAN LLC

Practice address

6540 South Ave
Boardman, OH 44512-3651

Phone

(330) 758-6165

Fax

(330) 533-2700

NPI assigned

Dec 22, 2010

Last updated

Dec 22, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew S Matta, DMD

Title

Sole Owner

Phone

(330) 533-3400

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1194029736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 BOARDMAN CANFIELD RD",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069029",
            "telephone_number": "330-533-3400",
            "fax_number": "330-533-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 SOUTH AVE",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445123651",
            "telephone_number": "330-758-6165",
            "fax_number": "330-533-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW S MATTA DMD BOARDMAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "330-533-3400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.