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General NPI Number Information
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NPI Number | 1578910600
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Entity Type | Individual
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Provider Name | MATTHEW TISSUE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 112 S CLAY ST STE A
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City | GREENVILLE
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State | MI
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Zip | 48838-1999
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Country | US
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Telephone | 616-881-2545
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Fax |
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Provider Business Mailing Address
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Address Line | 112 S CLAY ST STE A
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City | GREENVILLE
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State | MI
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Zip | 48838-1999
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Country | US
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Telephone | 616-881-2545
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 290102184
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License Number State | MI
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