Provider Demographics
NPI:1245443902
Name:DR W JOHN MATTHEWS DMD PC
Entity type:Organization
Organization Name:DR W JOHN MATTHEWS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-598-0907
Mailing Address - Street 1:7608 N UNION BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3874
Mailing Address - Country:US
Mailing Address - Phone:719-598-0907
Mailing Address - Fax:719-599-3253
Practice Address - Street 1:7608 N UNION BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3874
Practice Address - Country:US
Practice Address - Phone:719-598-0907
Practice Address - Fax:719-599-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty