Provider Demographics
NPI:1891813606
Name:BLEICKEN, MATTHEW PAGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAGE
Last Name:BLEICKEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3772 SATELLITE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5681
Mailing Address - Country:US
Mailing Address - Phone:770-497-1045
Mailing Address - Fax:770-623-6288
Practice Address - Street 1:3772 SATELLITE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5681
Practice Address - Country:US
Practice Address - Phone:770-497-1045
Practice Address - Fax:770-623-6288
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
GA120681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice