MEDICARE: DR. MATTHEW JAMES MAYNARD 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	1223G0001X	General Practice Dentistry	DE00005088	WA

General Provider Information

NPI Number	:	1497805337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JAMES MAYNARD DDS

Provider Business Mailing Address
First Line	:	3325 SMOKEY POINT DR STE 101
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7803
Country	:	US
Telephone Number	:	360-659-7633
Fax Number	:	360-658-0317

Provider Business Practice Location Address
First Line	:	3325 SMOKEY POINT DR STE 101
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7803
Country	:	US
Telephone Number	:	360-659-7633
Fax Number	:	360-658-0317

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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