Provider Demographics
NPI:1780662304
Name:DART, MATTHEW CHARLET (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLET
Last Name:DART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928A MCLENNAN DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4861
Mailing Address - Country:US
Mailing Address - Phone:808-254-7076
Mailing Address - Fax:
Practice Address - Street 1:21ST DENTAL COMPANY BUILDING 3089 D STREET
Practice Address - Street 2:
Practice Address - City:MCBH KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863
Practice Address - Country:US
Practice Address - Phone:808-257-3100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist