Provider Demographics
NPI:1770920902
Name:RADER, MATTHEW DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:RADER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 US 1
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4920
Mailing Address - Country:US
Mailing Address - Phone:772-546-8515
Mailing Address - Fax:
Practice Address - Street 1:10730 US 1
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-4920
Practice Address - Country:US
Practice Address - Phone:772-546-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice