Healthcare Provider Details

I. General information

NPI: 1376802058
Provider Name (Legal Business Name): MATTHEW J OBOIKOVITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 MARSHALL CT
MADISON WI
53705-2255
US

IV. Provider business mailing address

4422 3RD AVE
BRONX NY
10457-2545
US

V. Phone/Fax

Practice location:
  • Phone: 608-442-4400
  • Fax:
Mailing address:
  • Phone: 718-220-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7131-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: