Provider Demographics
NPI:1447773775
Name:JOHN, MATTHEW (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:JOHN
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 1:129 HILLCREST SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3504
Mailing Address - Country:US
Mailing Address - Phone:724-337-7800
Mailing Address - Fax:724-337-9982
Practice Address - Street 1:129 HILLCREST SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3504
Practice Address - Country:US
Practice Address - Phone:724-337-7800
Practice Address - Fax:724-337-9982
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424631223G0001X
MD164771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice