Healthcare Provider Details

I. General information

NPI: 1639603038
Provider Name (Legal Business Name): STEPHEN MATTHEWS DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HILLTOP VILLAGE CENTER DR SUITE A
EUREKA MO
63025-3922
US

IV. Provider business mailing address

97 HILLTOP VILLAGE CENTER DR SUITE A
EUREKA MO
63025-3922
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-9655
  • Fax: 636-938-9665
Mailing address:
  • Phone: 636-938-9655
  • Fax: 636-938-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number014735
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MCKOWN MATTHEWS
Title or Position: OWNER
Credential: DDS
Phone: 636-938-9655