Healthcare Provider Details

I. General information

NPI: 1790086957
Provider Name (Legal Business Name): MATTHEW JOHN WILLIAMS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 04/02/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 SE FOSTER RD
PORTLAND OR
97266-4661
US

IV. Provider business mailing address

6590 NE CAMPUS WAY
HILLSBORO OR
97124
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone: 855-433-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1364
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD11405
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: