MEDICARE: MR. MATTHEW STRUVE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11397	MN

General Provider Information

NPI Number	:	1083615405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW STRUVE DDS

Provider Business Mailing Address
First Line	:	PO BOX 705
Second Line	:
City	:	LINDSTROM
State	:	MN
Zip	:	55045-0705
Country	:	US
Telephone Number	:	651-257-4471
Fax Number	:	651-257-2017

Provider Business Practice Location Address
First Line	:	30554 PARK STREET
Second Line	:
City	:	LINDSTROM
State	:	MN
Zip	:	55045
Country	:	US
Telephone Number	:	651-257-4471
Fax Number	:	257-257-2017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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