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NPI Code Detail

MEDICARE: DR. RONALD A. MATUSON DMD

MEDICARE: DR. RONALD A. MATUSON DMD
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
1122300000XDentist12723MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1835867OTHERMAUNITED CONCORDIA
2X08513OTHERMABLUECROSS BLUE SHIELD

General Provider Information

NPI Number : 1306835608
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD A. MATUSON DMD
Provider Business Mailing Address
First Line : 138 RUSSELL ST
Second Line :
City : HADLEY
State : MA
Zip : 01035-9533
Country : US
Telephone Number : 413-584-6275
Fax Number : 413-584-5938
Provider Business Practice Location Address
First Line : 138 RUSSELL ST
Second Line :
City : HADLEY
State : MA
Zip : 01035-9533
Country : US
Telephone Number : 413-584-6275
Fax Number : 413-584-5938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 07/08/2007

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