Provider Demographics
NPI:1881760288
Name:MATTHIAS, MICHAEL DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:MATTHIAS
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 1:3844 KENNETT PIKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2305
Mailing Address - Country:US
Mailing Address - Phone:302-575-0100
Mailing Address - Fax:302-575-1933
Practice Address - Street 1:3844 KENNETT PIKE STE 206
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2305
Practice Address - Country:US
Practice Address - Phone:302-575-0100
Practice Address - Fax:302-575-1933
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-08-03
Deactivation Date:2007-03-02
Deactivation Code:
Reactivation Date:2008-10-10
Provider Licenses
StateLicense IDTaxonomies
DEG10001143122300000X
PADS028796L122300000X
PA28796122300000X
DE1143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist