Provider Demographics
NPI:1144585076
Name:ZWART, MATTHEW EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EVAN
Last Name:ZWART
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 1:123 ALBANY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1715
Mailing Address - Country:US
Mailing Address - Phone:712-737-3521
Mailing Address - Fax:712-737-4891
Practice Address - Street 1:123 ALBANY AVE SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1715
Practice Address - Country:US
Practice Address - Phone:712-737-3521
Practice Address - Fax:712-737-4891
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1704626Medicaid