MEDICARE: NEIL L MATTHEWS DDS PC

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	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1083247803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIL L MATTHEWS DDS PC

Provider Business Mailing Address
First Line	:	305 BARCLAY CIR STE 1004
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4572
Country	:	US
Telephone Number	:	248-656-0680
Fax Number	:	248-373-7672

Provider Business Practice Location Address
First Line	:	305 BARCLAY CIR STE 1004
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4572
Country	:	US
Telephone Number	:	248-656-0680
Fax Number	:	248-373-7672

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ANGEL MARIE WASMUND
Credential	:
Telephone Number	:	248-656-0680

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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