Provider Demographics
NPI:1750544557
Name:SMITH, MATTHEW J (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:SMITH
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 1:14704 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4102
Mailing Address - Country:US
Mailing Address - Phone:216-226-1052
Mailing Address - Fax:216-226-5677
Practice Address - Street 1:14704 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4102
Practice Address - Country:US
Practice Address - Phone:216-226-1052
Practice Address - Fax:216-226-5677
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist