Provider Demographics
NPI:1629590880
Name:DAVIDSON, MATTHEW S (DMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:DAVIDSON
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 1:5611 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3532
Mailing Address - Country:US
Mailing Address - Phone:813-397-5320
Mailing Address - Fax:
Practice Address - Street 1:5611 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3532
Practice Address - Country:US
Practice Address - Phone:813-397-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFD68303081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health