Provider Demographics
NPI:1326229337
Name:GEDDES, MATTHEW D (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:GEDDES
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 1:236 RIVER VISTA PL
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4078
Mailing Address - Country:US
Mailing Address - Phone:208-352-6360
Mailing Address - Fax:208-737-5255
Practice Address - Street 1:236 RIVER VISTA PL
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4078
Practice Address - Country:US
Practice Address - Phone:208-352-6360
Practice Address - Fax:208-737-5255
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-40411223G0001X
UT101557659923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist