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NPI Code Detail

MEDICARE: DR. MATTHEW GLENN LEPOWSKY DMD

MEDICARE: DR. MATTHEW GLENN LEPOWSKY DMD
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
11223G0001XGeneral Practice Dentistry12405CT

General Provider Information

NPI Number : 1083118483
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW GLENN LEPOWSKY DMD
Provider Business Mailing Address
First Line : 26 E GRANBY RD
Second Line :
City : GRANBY
State : CT
Zip : 06035-2201
Country : US
Telephone Number : 860-653-7596
Fax Number :
Provider Business Practice Location Address
First Line : 26 E GRANBY RD
Second Line :
City : GRANBY
State : CT
Zip : 06035-2201
Country : US
Telephone Number : 860-653-7596
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 01/23/2023

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