Provider Demographics
NPI:1942823661
Name:DOWNES, MATTHEW TIMOTHY (DMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:DOWNES
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 1:509 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2749
Mailing Address - Country:US
Mailing Address - Phone:239-677-0177
Mailing Address - Fax:
Practice Address - Street 1:3070 CRAIN HWY STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2831
Practice Address - Country:US
Practice Address - Phone:301-645-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25461122300000X
MD178501223G0001X
ORD11932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107961600Medicaid