Provider Demographics
NPI:1790803757
Name:DAVIS, MATTHEW C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:DAVIS
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 1:1775 GLENVIEW RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2956
Mailing Address - Country:US
Mailing Address - Phone:847-729-8400
Mailing Address - Fax:847-729-8408
Practice Address - Street 1:1775 GLENVIEW RD
Practice Address - Street 2:SUITE 208
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2956
Practice Address - Country:US
Practice Address - Phone:847-729-8400
Practice Address - Fax:847-729-8408
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics