Provider Demographics
NPI:1699275990
Name:LEFTWICH, MATTHEW STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:LEFTWICH
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 1:10522 S GLENSTONE PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2875
Mailing Address - Country:US
Mailing Address - Phone:225-769-5377
Mailing Address - Fax:
Practice Address - Street 1:10522 S GLENSTONE PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2875
Practice Address - Country:US
Practice Address - Phone:225-769-5377
Practice Address - Fax:225-769-7910
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics