Organization
MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC.
Active
Other names
Lakeview Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALVIN BRETT MATTESON DDS, FACP (OWNER/ PROSTHODONTIST)
(270) 853-2508
Entity
Organization
Contact information
Practice address
801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
(208) 664-0884
Mailing address
801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
(208) 664-0884
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-4027
ID
1223P0700X
Prosthodontics
Primary
D-4027
ID
Other
Enumeration date
07/24/2017
Last updated
07/21/2022
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