Provider Demographics
NPI:1568798726
Name:MATTHEW K CHOW DDS PA
Entity Type:Organization
Organization Name:MATTHEW K CHOW DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KING
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-924-8478
Mailing Address - Street 1:401 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4011
Mailing Address - Country:US
Mailing Address - Phone:601-924-8478
Mailing Address - Fax:601-925-1473
Practice Address - Street 1:401 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4011
Practice Address - Country:US
Practice Address - Phone:601-924-8478
Practice Address - Fax:601-925-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3525-091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty