Healthcare Provider Details

I. General information

NPI: 1578741203
Provider Name (Legal Business Name): THOMAS M MATTHES DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 OLD BALLAS RD SUITE 200
SAINT LOUIS MO
63141-7076
US

IV. Provider business mailing address

11710 OLD BALLAS RD SUITE 200
SAINT LOUIS MO
63141-7076
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-9777
  • Fax: 314-989-9779
Mailing address:
  • Phone: 314-989-9777
  • Fax: 314-989-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS M MATTHES
Title or Position: OWNER
Credential: DDS
Phone: 314-989-9777