Provider Demographics
NPI:1457512378
Name:MATTHEWS, NICHOLAS J (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
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 1:2700 MARINE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1124
Mailing Address - Country:US
Mailing Address - Phone:310-675-7768
Mailing Address - Fax:
Practice Address - Street 1:2700 MARINE AVE STE 105
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1124
Practice Address - Country:US
Practice Address - Phone:310-675-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist