Provider Demographics
NPI:1306095179
Name:MATTHEWS, THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MATTHEWS
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 1:2711 N HWY 89
Mailing Address - Street 2:STE 100
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1205
Mailing Address - Country:US
Mailing Address - Phone:801-737-5777
Mailing Address - Fax:801-782-4674
Practice Address - Street 1:2711 N HWY 89
Practice Address - Street 2:STE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-1205
Practice Address - Country:US
Practice Address - Phone:801-737-5777
Practice Address - Fax:801-782-4674
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6635899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist