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General NPI Number Information
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NPI Number | 1336298058
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Entity Type | Individual
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Provider Name | MATTHEW B KRIEWALDT DDS
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 2310 CRAVEN ST BLDG 3230
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City | SAN DIEGO
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State | CA
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Zip | 92136-5596
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Country | US
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Telephone | 619-701-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 6TH AVE UNIT 502
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City | SAN DIEGO
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State | CA
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Zip | 92103-5812
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Country | US
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Telephone | 619-701-3900
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6903-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 55521
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401413701
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License Number State | VA
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