Provider Demographics
NPI:1205624657
Name:MATTHEW MYNSBERGE, DDS INC & MATHEW RUGGLES, DDS INC, A PARTNERSHIP
Entity type:Organization
Organization Name:MATTHEW MYNSBERGE, DDS INC & MATHEW RUGGLES, DDS INC, A PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MYNSBERGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-633-5451
Mailing Address - Street 1:1331 S ELISEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2010
Mailing Address - Country:US
Mailing Address - Phone:415-461-1150
Mailing Address - Fax:415-461-1150
Practice Address - Street 1:1331 S ELISEO DR STE 1
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2010
Practice Address - Country:US
Practice Address - Phone:415-461-1150
Practice Address - Fax:415-461-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty