Individual
MR. MATT R AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1270 W MAIN ST, SUN PRAIRIE, WI 53590-1930
(608) 443-5482
(608) 837-9134
Mailing address
2901 W. BELTLINE HWY., SUITE 120, MADISON, WI 53713-4226
(608) 443-5500
(608) 441-1981
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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