Brian L Mattiacio, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

051528 Issued in NY

Practice address

1386 Hathaway Dr
Farmington, NY 14425-8973

Phone

(585) 742-1050

Fax

(585) 742-1011

NPI assigned

Apr 3, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922129261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1386 HATHAWAY DR",
            "city": "FARMINGTON",
            "state": "NY",
            "postal_code": "144258973",
            "telephone_number": "585-742-1050",
            "fax_number": "585-742-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1386 HATHAWAY DR",
            "city": "FARMINGTON",
            "state": "NY",
            "postal_code": "144258973",
            "telephone_number": "585-742-1050",
            "fax_number": "585-742-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIACIO",
        "first_name": "BRIAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "051528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Macomber, RN
• John Michael Manfred, MD
• Mark V Dimartino DDS
• Kara Martin, PA-C
• Kenneth E Mathis, P.A.
• Katie A. Schaeffer McCool, FNP-C
• Ralph McGarrity, RPH
• Courtney Rebecca Middleton, OTR/L, CHT, CLT
• Daniel Miller
• Millers Pharmacy of Farmington

• Orthodontics and Dentofacial Orthopedics Dentistry in Farmington, NY
• Providers in Farmington, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.