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Individual

DR. THOMAS MICHAEL MATTERN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
4609 E CHANDLER BLVD, PHOENIX, AZ 85048-0424
(480) 706-4600
Mailing address
4609 E CHANDLER BLVD, PHOENIX, AZ 85048-0424
(480) 706-4600

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3892
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
094136
AHCCCS PROVIDER ID
AZ
Enumeration date
07/05/2005
Last updated
05/21/2015
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