Provider Demographics
NPI:1992932123
Name:NAVIDOMSKIS, MATTHEW T (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:NAVIDOMSKIS
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 TAMIAMI TRL
Mailing Address - Street 2:SUITE #8
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6473
Mailing Address - Country:US
Mailing Address - Phone:941-249-9383
Mailing Address - Fax:
Practice Address - Street 1:2616 TAMIAMI TRL
Practice Address - Street 2:SUITE #8
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6473
Practice Address - Country:US
Practice Address - Phone:941-249-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist