Individual
MATTHEW DAVID WHITESIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 N 11TH AVE, GREELEY, CO 80631-2011
(970) 313-0353
(970) 351-7075
Mailing address
2930 11TH AVE, EVANS, CO 80620-1011
(970) 350-4606
(970) 350-4645
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9976
CO
1223P0221X
Pediatric Dentistry
Primary
9976
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65000846
—
CO
Enumeration date
07/17/2009
Last updated
06/30/2016
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