Provider Demographics
NPI:1881630150
Name:MCIVER, MATT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:A
Last Name:MCIVER
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 1:706 E RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5918
Mailing Address - Country:US
Mailing Address - Phone:440-322-7328
Mailing Address - Fax:440-322-7328
Practice Address - Street 1:706 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5918
Practice Address - Country:US
Practice Address - Phone:440-322-7328
Practice Address - Fax:440-322-7328
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH214251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice