MEDICARE: CHAD MATONE DENTAL SERVICES,P.L.L.C.

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

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	:	1659712214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD MATONE DENTAL SERVICES,P.L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 241785
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-0014
Country	:	US
Telephone Number	:	501-205-1084
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 N HILLS BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4539
Country	:	US
Telephone Number	:	501-835-4567
Fax Number	:	501-834-9178

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAD D. MATONE
Credential	:	D.D.S.
Telephone Number	:	501-205-1084

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	02/15/2019

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