Provider Demographics
NPI:1962923359
Name:ROBERT D MATTHEWS, DMD, PLLC
Entity type:Organization
Organization Name:ROBERT D MATTHEWS, DMD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-243-5333
Mailing Address - Street 1:1722 W ASTER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2833
Mailing Address - Country:US
Mailing Address - Phone:602-291-2482
Mailing Address - Fax:
Practice Address - Street 1:25225 N LAKE PLEASANT PKWY STE 1235
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1390
Practice Address - Country:US
Practice Address - Phone:623-243-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty