Provider Demographics
NPI:1013402486
Name:MEYERS, MATTHEW TODD
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:MEYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1725
Mailing Address - Country:US
Mailing Address - Phone:641-357-8111
Mailing Address - Fax:641-357-7713
Practice Address - Street 1:800 1ST AVE N STE 2
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1725
Practice Address - Country:US
Practice Address - Phone:641-357-8111
Practice Address - Fax:641-357-7713
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice