Provider Demographics
NPI:1962830455
Name:MATTHEIS HARTFORD DENTAL CLINIC, P.C.
Entity type:Organization
Organization Name:MATTHEIS HARTFORD DENTAL CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MATTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-528-6750
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:304 W. HWY 38 SUITE #138
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-0757
Mailing Address - Country:US
Mailing Address - Phone:605-528-6750
Mailing Address - Fax:605-528-6752
Practice Address - Street 1:304 W. HWY 38 SUITE #138
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-0757
Practice Address - Country:US
Practice Address - Phone:605-528-6750
Practice Address - Fax:605-528-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty