MEDICARE: DR. JOSHUA JAY MATTHEWS D.D.S

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	61368	KS
2	1223G0001X	General Practice Dentistry	6001152-15	WI

General Provider Information

NPI Number	:	1710415245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA JAY MATTHEWS D.D.S

Provider Business Mailing Address
First Line	:	4010 S CHURCH DR
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-5608
Country	:	US
Telephone Number	:	262-784-2449
Fax Number	:	262-784-7873

Provider Business Practice Location Address
First Line	:	4010 S CHURCH DR
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-5608
Country	:	US
Telephone Number	:	262-784-2449
Fax Number	:	262-784-7873

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

Provider Enumeration Date	:	05/29/2017
Last Update Date	:	09/06/2023

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