Provider Demographics
NPI:1659559854
Name:MATTHEWS, BRUCE ANDREW (DMD MDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANDREW
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DMD MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SOUTH MAIN ST
Mailing Address - Street 2:WELLINGTON SQUARE SUITE 106
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-836-4452
Mailing Address - Fax:724-836-1562
Practice Address - Street 1:1225 SOUTH MAIN ST
Practice Address - Street 2:WELLINGTON SQUARE SUITE 106
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-836-4452
Practice Address - Fax:724-836-1562
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025197L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564448OtherUNITED CONCORDIA