Provider Demographics
NPI:1174661136
Name:MATTERN, GEOFFREY KURTIS (DDS)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:KURTIS
Last Name:MATTERN
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 1:110 S FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1118
Mailing Address - Country:US
Mailing Address - Phone:724-238-6270
Mailing Address - Fax:
Practice Address - Street 1:110 S FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1118
Practice Address - Country:US
Practice Address - Phone:724-238-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024768L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice