Provider Demographics
NPI:1841397999
Name:WEST, MATTHEW A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:WEST
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 1:422 BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2322
Mailing Address - Country:US
Mailing Address - Phone:406-266-3402
Mailing Address - Fax:406-266-9084
Practice Address - Street 1:422 BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2322
Practice Address - Country:US
Practice Address - Phone:406-266-3402
Practice Address - Fax:406-266-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT16634OtherBLUECROSS/BLUESHEILD OF M
MT592030OtherUNITED CONCORDIA
MT110738Medicaid
MT5510401OtherBLUECHIP