Provider Demographics
NPI:1861596140
Name:ALM, MATTHEW JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:ALM
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 1:1616 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5152
Mailing Address - Country:US
Mailing Address - Phone:218-233-4267
Mailing Address - Fax:218-233-3294
Practice Address - Street 1:1616 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5152
Practice Address - Country:US
Practice Address - Phone:218-233-4267
Practice Address - Fax:218-233-3294
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist