Provider Demographics
NPI:1831363480
Name:DR MATTHEW SLATTERY DDS
Entity type:Organization
Organization Name:DR MATTHEW SLATTERY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PLLC
Authorized Official - Phone:757-595-2510
Mailing Address - Street 1:802 OLD OYSTER POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602
Mailing Address - Country:US
Mailing Address - Phone:757-595-2510
Mailing Address - Fax:757-596-7187
Practice Address - Street 1:802 OLD OYSTER POINT ROAD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-595-2510
Practice Address - Fax:757-596-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty