MEDICARE: DR. MATTHEW M NIEBER V D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 9292	FL

General Provider Information

NPI Number	:	1063593291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW M NIEBER V D.D.S.

Provider Business Mailing Address
First Line	:	1185 81ST ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-2726
Country	:	US
Telephone Number	:	727-345-6742
Fax Number	:

Provider Business Practice Location Address
First Line	:	2468 W BRANDON BLVD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4717
Country	:	US
Telephone Number	:	813-654-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/24/2008

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