Provider Demographics
NPI:1154862597
Name:STRATTON, MATTHEW (DMD, MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STRATTON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WOODED FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2198
Mailing Address - Country:US
Mailing Address - Phone:502-648-1098
Mailing Address - Fax:
Practice Address - Street 1:3935 DUPONT CIR STE D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4824
Practice Address - Country:US
Practice Address - Phone:502-897-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery