Provider Demographics
NPI:1225580392
Name:MATTHEW T. ERTL, D.M.D., P.C.
Entity Type:Organization
Organization Name:MATTHEW T. ERTL, D.M.D., P.C.
Other - Org Name:LAURELWOOD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ERTL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-687-7271
Mailing Address - Street 1:398 WEBB COVE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1933
Mailing Address - Country:US
Mailing Address - Phone:828-687-7271
Mailing Address - Fax:828-475-1331
Practice Address - Street 1:1978 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 30
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7766
Practice Address - Country:US
Practice Address - Phone:828-687-7271
Practice Address - Fax:828-475-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8680261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental