Provider Demographics
NPI:1306924477
Name:SMITH, MATTHEW E (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N14W23755 STONE RIDGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1684
Mailing Address - Country:US
Mailing Address - Phone:262-523-0220
Mailing Address - Fax:262-523-0390
Practice Address - Street 1:N14W23755 STONE RIDGE DR STE 260
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1684
Practice Address - Country:US
Practice Address - Phone:262-523-0220
Practice Address - Fax:262-523-0390
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice