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General NPI Number Information
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NPI Number | 1447128228
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Entity Type | Organization
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Legal Business Name | DEMATTHEW DENTAL, LLC
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 6729 LAKE RD
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City | WINDSOR
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State | WI
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Zip | 53598-9701
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Country | US
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Telephone | 608-846-5407
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Fax | 608-846-3493
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Provider Business Mailing Address
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Address Line | 6729 LAKE RD
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City | WINDSOR
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State | WI
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Zip | 53598-9701
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Country | US
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Telephone | 608-846-5407
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Fax | 608-846-3493
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MRS. MICHELLE LYNN DEMATTHEW
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Credential | DDS
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Telephone | 608-846-5407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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