Provider Demographics
NPI:1568845501
Name:CRONAN, MATTHEW S (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:CRONAN
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 1:2521 N LANDING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3460
Mailing Address - Country:US
Mailing Address - Phone:207-907-6389
Mailing Address - Fax:
Practice Address - Street 1:2521 N LANDING RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3460
Practice Address - Country:US
Practice Address - Phone:757-430-9448
Practice Address - Fax:757-427-5121
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18569531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice