Provider Demographics
NPI:1477292449
Name:KORTNI MATTESON DDS PLLC
Entity Type:Organization
Organization Name:KORTNI MATTESON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-760-1229
Mailing Address - Street 1:4710 N M 37 HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8351
Mailing Address - Country:US
Mailing Address - Phone:269-760-1229
Mailing Address - Fax:269-795-8881
Practice Address - Street 1:4710 N M 37 HWY
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8351
Practice Address - Country:US
Practice Address - Phone:269-760-1229
Practice Address - Fax:269-795-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-30
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental