Provider Demographics
NPI:1326262692
Name:MATTSON, RICHARD URBAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:URBAN
Last Name:MATTSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CASTLE GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1432
Mailing Address - Country:US
Mailing Address - Phone:301-260-2569
Mailing Address - Fax:
Practice Address - Street 1:3412 N HIGH ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2202
Practice Address - Country:US
Practice Address - Phone:301-924-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD74421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics