Provider Demographics
NPI:1164682837
Name:MATKOWSKY, PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MATKOWSKY
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 1:1664 ANDERSON HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-8056
Mailing Address - Country:US
Mailing Address - Phone:804-897-3339
Mailing Address - Fax:
Practice Address - Street 1:1664 ANDERSON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8056
Practice Address - Country:US
Practice Address - Phone:804-897-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice