Provider Demographics
NPI:1396958336
Name:SMITH, MATTHEW JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:JAMES
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:26711 WOODWARD AVENUE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070
Mailing Address - Country:US
Mailing Address - Phone:248-398-2320
Mailing Address - Fax:248-398-2320
Practice Address - Street 1:26711 WOODWARD AVENUE
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070
Practice Address - Country:US
Practice Address - Phone:248-398-2320
Practice Address - Fax:248-398-2320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist