Provider Demographics
NPI:1639603038
Name:STEPHEN MATTHEWS DDS LLC
Entity Type:Organization
Organization Name:STEPHEN MATTHEWS DDS LLC
Other - Org Name:EUREKA DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MCKOWN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-938-9655
Mailing Address - Street 1:97 HILLTOP VILLAGE CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3922
Mailing Address - Country:US
Mailing Address - Phone:636-938-9655
Mailing Address - Fax:636-938-9665
Practice Address - Street 1:97 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3922
Practice Address - Country:US
Practice Address - Phone:636-938-9655
Practice Address - Fax:636-938-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0147351223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty