Provider Demographics
NPI:1942276837
Name:MATUSZAK, MATTHEW S (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:MATUSZAK
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 1:10511 CITATION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-229-6624
Mailing Address - Fax:810-229-8835
Practice Address - Street 1:10511 CITATION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-229-6624
Practice Address - Fax:810-229-8835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist