Healthcare Provider Details

I. General information

NPI: 1356014963
Provider Name (Legal Business Name): MATTHEW DARROW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E OHIO ST
CLINTON MO
64735-2306
US

IV. Provider business mailing address

906 E OHIO ST
CLINTON MO
64735-2306
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-6114
  • Fax:
Mailing address:
  • Phone: 660-885-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7251
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2022022021
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: