Daniel John Maturo, D.D.S.
Individual provider Active NPI General Practice Dentistry · Stickney, IL
NPI 1720143902 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720143902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 6739 Pershing Rd
Stickney, IL 60402-4098 - Phone
- (708) 749-3770
- Fax
- (708) 484-6345
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161209001089 | IL | Order and Referring Only - Other (Non-Physician) | 6800176736 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019020084 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
6739 Pershing Rd
Stickney, IL 60402-4098
Mailing address
6739 Pershing Rd
Stickney, IL 60402-4098
Phone (708) 749-3770
Other providers in Stickney, IL
- Desiree Gonzalez
- Cristopher Guzman
- Emily Jacobs
- Tami Lynn Jimenez
- Thomas J Mack
- Milan Meghpara
- Manuel E Murillo Ruiz
- Scott Robert Musil
- Prakash Chand Navni
- Raymond H Nootens
All providers in Stickney, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.