Brian J Dematteo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19555 Issued in OH

Practice address

3830 Starrs Centre Dr
Suite #2
Canfield, OH 44406-8003

Phone

(330) 533-8699

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371081600000",
    "number": "1376691378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 STARRS CENTRE DR",
            "address_2": "SUITE #2",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068003",
            "telephone_number": "330-533-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 STARRS CENTRE DR",
            "address_2": "SUITE #2",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068003",
            "telephone_number": "330-533-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTEO",
        "first_name": "BRIAN",
        "middle_name": "J",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2013-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina M Dascenzo, R.PH., PHARM.D.
• David N Baer D PM Inc
• David N Baer DPM
• Rea Joann Dawson
• Grace Deegan, LPC
• James Charles Demidovich, DO
• Dental Express, LLC
• Gayle Derosa, L.P.N.
• Michael A Derosa, DO
• Diabetic Supplies, Inc.

• General Practice Dentistry in Canfield, OH
• Providers in Canfield, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.