Provider Demographics
NPI:1578850467
Name:DR. RICHARD U. MATTSON D.M.D., P.A.
Entity Type:Organization
Organization Name:DR. RICHARD U. MATTSON D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:U
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-924-2405
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-0250
Mailing Address - Country:US
Mailing Address - Phone:301-924-2405
Mailing Address - Fax:301-774-4167
Practice Address - Street 1:3412 N HIGH ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2202
Practice Address - Country:US
Practice Address - Phone:301-924-2405
Practice Address - Fax:301-774-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD74421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty