MEDICARE: DR. JEREMY BOYCE MATTHEWS D.M.D.

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	5142959	UT

General Provider Information

NPI Number	:	1407925233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY BOYCE MATTHEWS D.M.D.

Provider Business Mailing Address
First Line	:	1305 N COMMERCE DR
Second Line	:	SUITE 220
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84043-5305
Country	:	US
Telephone Number	:	801-766-4944
Fax Number	:	801-768-0327

Provider Business Practice Location Address
First Line	:	1305 N COMMERCE DR
Second Line	:	SUITE 220
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84043-5305
Country	:	US
Telephone Number	:	801-766-4944
Fax Number	:	801-768-0327

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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