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General NPI Number Information
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NPI Number | 1245577329
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Entity Type | Organization
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Legal Business Name | CHAD D MATONE DDS PA
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 230 PINE BLUFF ST
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City | MALVERN
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State | AR
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Zip | 72104-4228
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Country | US
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Telephone | 501-337-4908
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Fax | 501-337-9929
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Provider Business Mailing Address
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Address Line | 230 PINE BLUFF ST
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City | MALVERN
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State | AR
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Zip | 72104-4228
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Country | US
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Telephone | 501-337-4908
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Fax | 501-337-9929
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD D MATONE
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Credential | D.D.S
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Telephone | 901-490-1293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3574
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License Number State | AR
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