Provider Demographics
NPI:1457344160
Name:MATTHEWS, STANLEY GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:GORDON
Last Name:MATTHEWS
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 1:5137 PEBBLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3633
Mailing Address - Country:US
Mailing Address - Phone:937-836-4732
Mailing Address - Fax:
Practice Address - Street 1:2139 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5610
Practice Address - Country:US
Practice Address - Phone:937-278-8804
Practice Address - Fax:937-278-8804
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice