MEDICARE: THOMAS MATTHEWS D.M.D

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	6635899	UT

General Provider Information

NPI Number	:	1306095179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MATTHEWS D.M.D

Provider Business Mailing Address
First Line	:	2711 N HWY 89
Second Line	:	STE 100
City	:	OGDEN
State	:	UT
Zip	:	84404-1205
Country	:	US
Telephone Number	:	801-737-5777
Fax Number	:	801-782-4674

Provider Business Practice Location Address
First Line	:	2711 N HWY 89
Second Line	:	STE 100
City	:	OGDEN
State	:	UT
Zip	:	84404-1205
Country	:	US
Telephone Number	:	801-737-5777
Fax Number	:	801-782-4674

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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Directions to “ THOMAS MATTHEWS D.M.D” Practice Location

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