Healthcare Provider Details

I. General information

NPI: 1548269327
Provider Name (Legal Business Name): CHRISTOPHER J MATTHEWS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 NE 7TH ST
GRANTS PASS OR
97526-1634
US

IV. Provider business mailing address

859 NE 7TH ST
GRANTS PASS OR
97526-1634
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-0860
  • Fax: 541-476-1038
Mailing address:
  • Phone: 541-474-0860
  • Fax: 541-476-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD4956
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: