Provider Demographics
NPI:1962619866
Name:FLUGSTAD, MATTHEW DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:FLUGSTAD
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 1:555 DAYTON STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:424-672-7272
Mailing Address - Fax:425-672-1957
Practice Address - Street 1:555 DAYTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:424-672-7272
Practice Address - Fax:425-672-1957
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist