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Organization
MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC.
Active
Organization
MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC.
Active
Other names
Lakeview Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALVIN BRETT MATTESON DDS, FACP (OWNER/ PROSTHODONTIST)
(270) 853-2508
Entity
Organization
Contact information
Practice address
801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
(208) 664-0884
Mailing address
801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
(208) 664-0884
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-4027
ID
1223P0700X
Prosthodontics
Primary
D-4027
ID
Other
Enumeration date
07/24/2017
Last updated
07/21/2022
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