Healthcare Provider Details

I. General information

NPI: 1083247803
Provider Name (Legal Business Name): NEIL L MATTHEWS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BARCLAY CIR STE 1004
ROCHESTER HILLS MI
48307-4572
US

IV. Provider business mailing address

305 BARCLAY CIR STE 1004
ROCHESTER HILLS MI
48307-4572
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-0680
  • Fax: 248-373-7672
Mailing address:
  • Phone: 248-656-0680
  • Fax: 248-373-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGEL MARIE WASMUND
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-656-0680