Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN 8925 | FL |
NPI | 1003055054 |
---|---|
Provider Name | Dr. Albert H. Mattia |
First Address | Gainesville, FL 32610-0405 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2009 |
Last Update Date | 16/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AM 1247356 | DEA (01) | FL |