Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
MR. MATT R AGNEW
Active
Individual
MR. MATT R AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
6179-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33815700
—
WI
Enumeration date
11/15/2007
Last updated
05/04/2021
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