Provider Demographics
NPI:1437291127
Name:SHECHTMAN, MATTHEW W (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:SHECHTMAN
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 1:639 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1103
Mailing Address - Country:US
Mailing Address - Phone:856-964-0979
Mailing Address - Fax:
Practice Address - Street 1:639 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1103
Practice Address - Country:US
Practice Address - Phone:856-964-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019757-L1223G0001X
NJ22DI01118000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI01118000OtherLICENSE
PADS-019757-LOtherLICENSE