Provider Demographics
NPI:1174957492
Name:LORI A MATTURRO, DDS,PC
Entity type:Organization
Organization Name:LORI A MATTURRO, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATTURRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-446-3686
Mailing Address - Street 1:6726 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5907
Mailing Address - Country:US
Mailing Address - Phone:718-446-3686
Mailing Address - Fax:
Practice Address - Street 1:6084 71ST ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2914
Practice Address - Country:US
Practice Address - Phone:718-803-3020
Practice Address - Fax:718-803-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty