Provider Demographics
NPI:1922245695
Name:MATTHEWS DENTAL GROUP, PA
Entity Type:Organization
Organization Name:MATTHEWS DENTAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-696-8681
Mailing Address - Street 1:1509 EMERALD PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5502
Mailing Address - Country:US
Mailing Address - Phone:979-696-8681
Mailing Address - Fax:979-680-1330
Practice Address - Street 1:1509 EMERALD PKWY STE 105
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5502
Practice Address - Country:US
Practice Address - Phone:979-696-8681
Practice Address - Fax:979-680-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty