Provider Demographics
NPI:1942328646
Name:NOORDA, MATTHEW L (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:NOORDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12226 S 1000 E
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8205
Mailing Address - Country:US
Mailing Address - Phone:801-553-2350
Mailing Address - Fax:801-553-2432
Practice Address - Street 1:12226 S 1000 E
Practice Address - Street 2:SUITE 8
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8205
Practice Address - Country:US
Practice Address - Phone:801-553-2350
Practice Address - Fax:801-553-2432
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT941457329922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist