Provider Demographics
NPI:1649284530
Name:STEMPOWSKI, MATTHEW ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:STEMPOWSKI
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 1:1936 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3683
Mailing Address - Country:US
Mailing Address - Phone:440-233-4155
Mailing Address - Fax:440-240-8715
Practice Address - Street 1:1936 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3683
Practice Address - Country:US
Practice Address - Phone:440-213-4155
Practice Address - Fax:440-240-8715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300207201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
34-1969173OtherFEDERAL TAX ID