Provider Demographics
NPI:1720961204
Name:MATAMORAS DENTAL P.L.L.C
Entity type:Organization
Organization Name:MATAMORAS DENTAL P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:MASIHUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-491-4012
Mailing Address - Street 1:2 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1404
Mailing Address - Country:US
Mailing Address - Phone:570-491-4012
Mailing Address - Fax:
Practice Address - Street 1:2 AVENUE L
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1404
Practice Address - Country:US
Practice Address - Phone:570-491-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty