Provider Demographics
NPI:1356674691
Name:HEALY, MATTHEW GORDON (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GORDON
Last Name:HEALY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2820 BAKER RD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1181
Mailing Address - Country:US
Mailing Address - Phone:734-424-0053
Mailing Address - Fax:734-424-0056
Practice Address - Street 1:2820 BAKER RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1181
Practice Address - Country:US
Practice Address - Phone:734-424-0053
Practice Address - Fax:734-424-0056
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010200461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics