MEDICARE: DR. MATTHEW THOMAS STREELMAN DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	MD61048195	WA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE60143704	WA

General Provider Information

NPI Number	:	1093055097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW THOMAS STREELMAN DDS, MD

Provider Business Mailing Address
First Line	:	PO BOX 248986
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73124-8986
Country	:	US
Telephone Number	:	877-667-7669
Fax Number	:	888-920-7457

Provider Business Practice Location Address
First Line	:	3023 80TH AVE SE STE 200
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-6014
Country	:	US
Telephone Number	:	206-690-5417
Fax Number	:

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	12/17/2021

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