Provider Demographics
NPI:1457478851
Name:PETER MATKOWSKY DDS INC.
Entity Type:Organization
Organization Name:PETER MATKOWSKY DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-897-3339
Mailing Address - Street 1:1664 ANDERSON HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-8056
Mailing Address - Country:US
Mailing Address - Phone:804-897-3339
Mailing Address - Fax:
Practice Address - Street 1:1664 ANDERSON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8056
Practice Address - Country:US
Practice Address - Phone:804-897-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty