MEDICARE: MATTHEW T STREELMAN DDS MD PLLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1689244188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW T STREELMAN DDS MD PLLC

Provider Business Mailing Address
First Line	:	3023 80TH AVE SE STE 200
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-6014
Country	:	US
Telephone Number	:	877-667-7669
Fax Number	:	405-848-0033

Provider Business Practice Location Address
First Line	:	3023 80TH AVE SE STE 200
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-6014
Country	:	US
Telephone Number	:	877-667-7669
Fax Number	:	405-848-0033

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW T STREELMAN
Credential	:	DDS MD
Telephone Number	:	877-667-7669

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	01/20/2022

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