Healthcare Provider Details

I. General information

NPI: 1396317400
Provider Name (Legal Business Name): TIMOTHY MATTHEWS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 S SPANISH SUN WAY
MERIDIAN ID
83642-8024
US

IV. Provider business mailing address

1740 S SPANISH SUN WAY
MERIDIAN ID
83642-8024
US

V. Phone/Fax

Practice location:
  • Phone: 208-370-5620
  • Fax:
Mailing address:
  • Phone: 208-370-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61404678
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1002647
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-5368
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: