Provider Demographics
NPI:1417269200
Name:EPSTEIN, MATTHEW SHANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SHANE
Last Name:EPSTEIN
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 1:7900 E GREEN LAKE DR N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4800
Mailing Address - Country:US
Mailing Address - Phone:206-641-7212
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREEN LAKE DR N
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4800
Practice Address - Country:US
Practice Address - Phone:206-641-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60277222122300000X
WADE60277222204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist