Provider Demographics
NPI:1770773533
Name:MATONE AND COOPER MOBILE DENTISTRY,PLLC.
Entity type:Organization
Organization Name:MATONE AND COOPER MOBILE DENTISTRY,PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-676-6770
Mailing Address - Street 1:123 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-2805
Mailing Address - Country:US
Mailing Address - Phone:501-676-6770
Mailing Address - Fax:501-676-5147
Practice Address - Street 1:123 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2805
Practice Address - Country:US
Practice Address - Phone:501-676-6770
Practice Address - Fax:501-676-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty