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General NPI Number Information
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NPI Number | 1982856209
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Entity Type | Individual
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Provider Name | JOSEPH CLAIR MATTINGLY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 957 E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2307
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Country | US
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Telephone | 219-696-0250
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Fax | 219-696-7099
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Provider Business Mailing Address
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Address Line | 957 E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2307
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Country | US
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Telephone | 219-696-0250
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Fax | 219-696-7099
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010630A
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License Number State | IN
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