MEDICARE: DR. BETH M MATILE DMD

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	6203	OR

General Provider Information

NPI Number	:	1790783058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH M MATILE DMD

Provider Business Mailing Address
First Line	:	PO BOX 22230
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97269-2230
Country	:	US
Telephone Number	:	503-659-7730
Fax Number	:	503-659-0746

Provider Business Practice Location Address
First Line	:	6201 SE HARMONY RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2175
Country	:	US
Telephone Number	:	503-659-7730
Fax Number	:	503-659-0746

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/08/2007

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