Provider Demographics
NPI:1124567342
Name:YEKIKIAN, MATTHEW R (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:YEKIKIAN
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:8480 WOODBURY XING STE 120
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9406
Mailing Address - Country:US
Mailing Address - Phone:651-358-7025
Mailing Address - Fax:
Practice Address - Street 1:8480 WOODBURY XING STE 120
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9406
Practice Address - Country:US
Practice Address - Phone:651-358-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND147021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery