Healthcare Provider Details

I. General information

NPI: 1154702140
Provider Name (Legal Business Name): MATTHEW TURNER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 SAMPSON ST. FISHER DENTAL CLINIC
GREAT LAKES IL
60088
US

IV. Provider business mailing address

1107 HIGHLAND ST
COLUMBUS OH
43201-3277
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-2469
  • Fax:
Mailing address:
  • Phone: 716-604-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number16591
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number16591
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16591
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: