Healthcare Provider Details

I. General information

NPI: 1578662045
Provider Name (Legal Business Name): ALVIN BRETT MATTESON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SCHLAESER WAY
RHINEYVILLE KY
40162
US

IV. Provider business mailing address

225 SCHLAESER WAY
RHINEYVILLE KY
40162
US

V. Phone/Fax

Practice location:
  • Phone: 270-853-2508
  • Fax:
Mailing address:
  • Phone: 270-853-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD-4027
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-4027
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: