Provider Demographics
NPI:1598177115
Name:CALKINS, MATTHEW DON (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DON
Last Name:CALKINS
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 1:108 GRESHAM ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1910
Mailing Address - Country:US
Mailing Address - Phone:801-228-8200
Mailing Address - Fax:406-377-8267
Practice Address - Street 1:116 N MEADE AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1604
Practice Address - Country:US
Practice Address - Phone:406-377-8265
Practice Address - Fax:406-377-8267
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist