Provider Demographics
NPI:1487746384
Name:MATZA, BARRY I (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:I
Last Name:MATZA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 TOWN CENTER CIR
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1049
Mailing Address - Country:US
Mailing Address - Phone:561-368-3480
Mailing Address - Fax:561-368-2380
Practice Address - Street 1:5100 TOWN CENTER CIR
Practice Address - Street 2:SUITE #106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1049
Practice Address - Country:US
Practice Address - Phone:561-368-3480
Practice Address - Fax:561-368-2380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics