Provider Demographics
NPI:1972515732
Name:BEDNAR, MATTHEW PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAUL
Last Name:BEDNAR
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 1:6163 NW 86TH STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2241
Mailing Address - Country:US
Mailing Address - Phone:515-331-3070
Mailing Address - Fax:515-331-1875
Practice Address - Street 1:6163 NW 86TH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2241
Practice Address - Country:US
Practice Address - Phone:515-331-3070
Practice Address - Fax:515-331-1875
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist