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General NPI Number Information
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NPI Number | 1336122118
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Entity Type | Individual
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Provider Name | MATTHEW S. CLEGG D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 802 7TH ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2022
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Country | US
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Telephone | 509-758-4181
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Fax | 509-758-4756
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Provider Business Mailing Address
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Address Line | 802 7TH ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2022
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Country | US
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Telephone | 509-758-4181
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Fax | 509-758-4756
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DE00010180
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License Number State | WA
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