Provider Demographics
NPI:1093917957
Name:BINNINGER, MATTHEW SAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SAM
Last Name:BINNINGER
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:N106W17075 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3969
Mailing Address - Country:US
Mailing Address - Phone:262-424-8592
Mailing Address - Fax:
Practice Address - Street 1:3104 N 93RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3559
Practice Address - Country:US
Practice Address - Phone:414-442-3360
Practice Address - Fax:414-442-3360
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5623-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice