Provider Demographics
NPI:1164950440
Name:THOMAS, MATTHEW BRYSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRYSON
Last Name:THOMAS
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 1:6080 DIXIE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3493
Mailing Address - Country:US
Mailing Address - Phone:248-627-2106
Mailing Address - Fax:
Practice Address - Street 1:6080 DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3493
Practice Address - Country:US
Practice Address - Phone:248-627-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010222301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice