Provider Demographics
NPI:1821149337
Name:MATONE, CHAD D (DDS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:D
Last Name:MATONE
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 1:7400 N HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-4539
Mailing Address - Country:US
Mailing Address - Phone:501-835-4567
Mailing Address - Fax:501-834-9178
Practice Address - Street 1:7400 N HILLS BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-4539
Practice Address - Country:US
Practice Address - Phone:501-835-4567
Practice Address - Fax:501-834-9178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164408608Medicaid
AR3574OtherDELTA DENTAL
AR1876078OtherUNITED CONCORDIA
AR5Y906OtherAR BLUE CROSS BLUE SHIELD