Provider Demographics
NPI:1073734000
Name:MATTHEWS, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ESTEL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-922-1045
Mailing Address - Fax:501-922-6217
Practice Address - Street 1:110 ESTEL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-922-1045
Practice Address - Fax:501-922-6217
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist