Provider Demographics
NPI:1750644498
Name:MATTHEW S. CLEGG, DDS, MS, P.S.
Entity Type:Organization
Organization Name:MATTHEW S. CLEGG, DDS, MS, P.S.
Other - Org Name:CLEARWATER ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:509-758-4181
Mailing Address - Street 1:802 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2022
Mailing Address - Country:US
Mailing Address - Phone:509-758-4181
Mailing Address - Fax:509-758-4756
Practice Address - Street 1:802 7TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2022
Practice Address - Country:US
Practice Address - Phone:509-758-4181
Practice Address - Fax:509-758-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty