Provider Demographics
NPI:1023113834
Name:STREPKA, MATTHEW ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:STREPKA
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 1:1108 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-3030
Mailing Address - Country:US
Mailing Address - Phone:979-541-5400
Mailing Address - Fax:
Practice Address - Street 1:1108 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-3030
Practice Address - Country:US
Practice Address - Phone:979-541-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174963205Medicaid