Healthcare Provider Details

I. General information

NPI: 1891707824
Provider Name (Legal Business Name): NEIL LENDON MATTHEWS D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 MAIN STREET SUITE 412
ROCHESTER MI
48307
US

IV. Provider business mailing address

1359 SIGNAL LANE
LAKE ORION MI
48360
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-0680
  • Fax: 248-656-1321
Mailing address:
  • Phone: 248-620-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14851
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: