Provider Demographics
NPI:1811985195
Name:MATSON, DAVID M (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MATSON
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 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2021
Mailing Address - Country:US
Mailing Address - Phone:508-865-2622
Mailing Address - Fax:508-865-1676
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2021
Practice Address - Country:US
Practice Address - Phone:508-865-2622
Practice Address - Fax:508-865-1676
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice