Provider Demographics
NPI:1679301873
Name:TRESOLINE, MATTHEW J
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:TRESOLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-0550
Mailing Address - Country:US
Mailing Address - Phone:315-617-3912
Mailing Address - Fax:
Practice Address - Street 1:3 PARKSIDE CT BLDG 1
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5643
Practice Address - Country:US
Practice Address - Phone:315-927-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist