Provider Demographics
NPI:1699852251
Name:MATTHEWS, BARRIE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRIE
Middle Name:LEE
Last Name:MATTHEWS
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 1:2600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-3929
Mailing Address - Country:US
Mailing Address - Phone:406-234-3536
Mailing Address - Fax:
Practice Address - Street 1:2600 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3929
Practice Address - Country:US
Practice Address - Phone:406-234-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0025363Medicaid