Healthcare Provider Details

I. General information

NPI: 1265366298
Provider Name (Legal Business Name): MATTHEW SCOTT GONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 N GARFIELD AVE
LOVELAND CO
80537-5500
US

IV. Provider business mailing address

3250 W GREENWAY RD UNIT 164
PHOENIX AZ
85053-3926
US

V. Phone/Fax

Practice location:
  • Phone: 970-541-2183
  • Fax:
Mailing address:
  • Phone: 559-623-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206681
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: