Provider Demographics
NPI:1669088852
Name:DEJONG, MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEJONG
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:KLEBER DENTAL CLINIC
Mailing Address - Street 2:KLEBER KASERNE, MANNHEIMER STR. 3287
Mailing Address - City:KAISERSLAUTERN
Mailing Address - State:RHEINLAND PFALZ
Mailing Address - Zip Code:67657
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KLEBER DENTAL CLINIC
Practice Address - Street 2:BLDG 3287
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09227
Practice Address - Country:US
Practice Address - Phone:314-590-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD113391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice