Provider Demographics
NPI:1982157749
Name:MATTHEWS, BRENDAN (DMD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:MATTHEWS
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 1:521 MT PLEASANT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1993
Mailing Address - Country:US
Mailing Address - Phone:570-346-7301
Mailing Address - Fax:
Practice Address - Street 1:521 MT PLEASANT DR STE 102
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1993
Practice Address - Country:US
Practice Address - Phone:570-346-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041687122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist