Provider Demographics
NPI:1790783058
Name:MATILE, BETH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:M
Last Name:MATILE
Suffix:
Gender:F
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:PO BOX 22230
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2230
Mailing Address - Country:US
Mailing Address - Phone:503-659-7730
Mailing Address - Fax:503-659-0746
Practice Address - Street 1:6201 SE HARMONY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2175
Practice Address - Country:US
Practice Address - Phone:503-659-7730
Practice Address - Fax:503-659-0746
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice