Provider Demographics
NPI:1982247631
Name:MATTHEW C JANDA, DDS
Entity Type:Organization
Organization Name:MATTHEW C JANDA, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-522-4050
Mailing Address - Street 1:801 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4740
Mailing Address - Country:US
Mailing Address - Phone:970-522-4050
Mailing Address - Fax:970-522-4067
Practice Address - Street 1:801 IRIS DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4740
Practice Address - Country:US
Practice Address - Phone:970-522-4050
Practice Address - Fax:970-522-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty