Provider Demographics
NPI:1992049811
Name:MICHAEL MATHEWS, DDS, P.C.
Entity type:Organization
Organization Name:MICHAEL MATHEWS, DDS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-385-7427
Mailing Address - Street 1:409 LAYNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1060
Mailing Address - Country:US
Mailing Address - Phone:319-752-1444
Mailing Address - Fax:319-752-8468
Practice Address - Street 1:409 LAYNE DR
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1060
Practice Address - Country:US
Practice Address - Phone:319-752-1444
Practice Address - Fax:319-752-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8053122300000X
IA8186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty