Healthcare Provider Details

I. General information

NPI: 1831896737
Provider Name (Legal Business Name): MICHAELA PAIGE MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 LAYNE DR
WEST BURLINGTON IA
52655-1060
US

IV. Provider business mailing address

701 LAYNE DR UNIT 2
WEST BURLINGTON IA
52655-1082
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-1444
  • Fax:
Mailing address:
  • Phone: 319-931-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10321
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: