Provider Demographics
NPI:1770014904
Name:MATTHEW R. HEALY D.D.S., P.A.
Entity Type:Organization
Organization Name:MATTHEW R. HEALY D.D.S., P.A.
Other - Org Name:TINY TEETH PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-202-0140
Mailing Address - Street 1:3933 N MAIZE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-9618
Mailing Address - Country:US
Mailing Address - Phone:316-202-0140
Mailing Address - Fax:316-202-0141
Practice Address - Street 1:3933 N MAIZE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-9618
Practice Address - Country:US
Practice Address - Phone:316-202-0140
Practice Address - Fax:316-202-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS605021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty