Provider Demographics
NPI:1093911513
Name:HEALY, MATTHEW (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HEALY
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 1:1501 N GRAYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7245
Mailing Address - Country:US
Mailing Address - Phone:913-220-8907
Mailing Address - Fax:
Practice Address - Street 1:3933 N. MAIZE RD
Practice Address - Street 2:ML 2006
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-3039
Practice Address - Country:US
Practice Address - Phone:913-220-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25891223P0221X
KS605021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry