# MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeview Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679096523
- **Authorized official:** DR. ALVIN BRETT MATTESON DDS, FACP (OWNER/ PROSTHODONTIST)
- **Authorized official phone:** (270) 853-2508

## Contact information

- **Practice address:** 801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
- **Practice address phone:** (208) 664-0884
- **Mailing address:** 801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
- **Mailing address phone:** (208) 664-0884

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-4027 | ID | — |
| 1223P0700X | Prosthodontics | D-4027 | ID | Yes |

## Other

- **Enumeration date:** 07/24/2017
- **Last updated:** 07/21/2022