MEDICARE: DR. TIMOTHY MATTHEWS DDS

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	DE61404678	WA
2	122300000X	Dentist	1002647	WI
3	1223G0001X	General Practice Dentistry	D-5368	ID

General Provider Information

NPI Number	:	1396317400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MATTHEWS DDS

Provider Business Mailing Address
First Line	:	1740 S SPANISH SUN WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8024
Country	:	US
Telephone Number	:	208-370-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 S SPANISH SUN WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8024
Country	:	US
Telephone Number	:	208-370-5620
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	05/29/2026

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