Provider Demographics
NPI:1508991043
Name:YOUR DENTISTRY TODAY
Entity Type:Organization
Organization Name:YOUR DENTISTRY TODAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATTHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-575-0100
Mailing Address - Street 1:3844 KENNETT PIKE STE 206
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2305
Mailing Address - Country:US
Mailing Address - Phone:302-575-0100
Mailing Address - Fax:
Practice Address - Street 1:3844 KENNETT PIKE
Practice Address - Street 2:SUITE 206
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2305
Practice Address - Country:US
Practice Address - Phone:302-575-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001158408Medicaid