MEDICARE: MATTHEW CRONAN, DMD, PLLC

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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821103714	OTHER		PROVIDER NPI
2	13966489811	OTHER		PROVIDER NPI

General Provider Information

NPI Number	:	1255042073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW CRONAN, DMD, PLLC

Provider Business Mailing Address
First Line	:	2521 N LANDING RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3460
Country	:	US
Telephone Number	:	757-430-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 N LANDING RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3460
Country	:	US
Telephone Number	:	757-430-9448
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	SHANNON CRONAN
Credential	:
Telephone Number	:	757-430-9448

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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