Provider Demographics
NPI:1275535387
Name:IWINSKI, MATTHEW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:IWINSKI
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 1:45 PINE ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5409
Mailing Address - Country:US
Mailing Address - Phone:203-966-5606
Mailing Address - Fax:203-966-3239
Practice Address - Street 1:45 PINE ST
Practice Address - Street 2:STE 1A
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5409
Practice Address - Country:US
Practice Address - Phone:203-966-5606
Practice Address - Fax:203-966-3239
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT082691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice