Provider Demographics
NPI:1932298460
Name:MATTSCHECK, DONNA JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:MATTSCHECK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WASHINGTON AVE N
Mailing Address - Street 2:#308
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 ABERDEEN ST NE
Practice Address - Street 2:#140
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4808
Practice Address - Country:US
Practice Address - Phone:763-772-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics