Provider Demographics
NPI:1578882262
Name:SCHWEDFEGER, MATTHEW OWEN (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OWEN
Last Name:SCHWEDFEGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1303
Mailing Address - Country:US
Mailing Address - Phone:585-385-2033
Mailing Address - Fax:585-385-9210
Practice Address - Street 1:20 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1303
Practice Address - Country:US
Practice Address - Phone:585-385-2033
Practice Address - Fax:585-385-9210
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice