Provider Demographics
NPI:1720508179
Name:MATTHEW S. AMES D.D.S., M.S. PLLC.
Entity type:Organization
Organization Name:MATTHEW S. AMES D.D.S., M.S. PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-236-1322
Mailing Address - Street 1:1550 30TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-236-1322
Mailing Address - Fax:218-236-0719
Practice Address - Street 1:1550 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5150
Practice Address - Country:US
Practice Address - Phone:218-236-1322
Practice Address - Fax:218-236-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty