Provider Demographics
NPI:1922209881
Name:GARSON, MATTHEW LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:GARSON
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 1:4428 GRAF ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0605
Mailing Address - Country:US
Mailing Address - Phone:406-628-6157
Mailing Address - Fax:
Practice Address - Street 1:227 SPOONER RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7813
Practice Address - Country:US
Practice Address - Phone:406-388-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice