# PROFESSIONAL DENTAL ASSOCIATES PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jensen Shroyer Anderson PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750550109
- **Authorized official:** DR. KEVIN T MATHEWSON DDS (DENTIST OWNER)
- **Authorized official phone:** (989) 382-7227

## Contact information

- **Practice address:** 98 NORTHERN AVENUE, BARRYTON, MI 49305
- **Practice address phone:** (989) 382-7227
- **Practice address fax:** (989) 382-7227
- **Mailing address:** 98 NORTHERN AVENUE, PO BOX 244, BARRYTON, MI 49305
- **Mailing address phone:** (989) 382-7227
- **Mailing address fax:** (989) 382-7227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 10102 | MI | Yes |
| 1223G0001X | General Practice Dentistry | 16945 | MI | — |
| 1223G0001X | General Practice Dentistry | 19296 | MA | — |

## Other

- **Enumeration date:** 02/29/2008
- **Last updated:** 02/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8012370 | BC BS | MI |