MEDICARE: DR. MATTHEW J WEST 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
1	122300000X	Dentist	1176	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104945443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J WEST DMD

Provider Business Mailing Address
First Line	:	PO BOX 3501
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559-3501
Country	:	US
Telephone Number	:	907-543-6272
Fax Number	:	907-543-6393

Provider Business Practice Location Address
First Line	:	829 CHEIF EDDIE HOFFMAN HWY
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-6272
Fax Number	:	907-543-6393

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/09/2007

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