Provider Demographics
NPI:1669640132
Name:MATVIAS, FREDRICK MICHAEL (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:MICHAEL
Last Name:MATVIAS
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 CROOKS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4732
Mailing Address - Country:US
Mailing Address - Phone:248-649-5399
Mailing Address - Fax:248-649-5427
Practice Address - Street 1:2833 CROOKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4732
Practice Address - Country:US
Practice Address - Phone:248-649-5399
Practice Address - Fax:248-649-5427
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010116591223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics