Provider Demographics
NPI:1457571705
Name:MATTHEIS, SCOTT MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARK
Last Name:MATTHEIS
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 1:304 W. HWY 38
Mailing Address - Street 2:STE. 138
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-0757
Mailing Address - Country:US
Mailing Address - Phone:605-528-6750
Mailing Address - Fax:605-528-6752
Practice Address - Street 1:304 W. HWY 38
Practice Address - Street 2:STE. 138
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-0757
Practice Address - Country:US
Practice Address - Phone:605-528-6750
Practice Address - Fax:605-528-6752
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-7331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice