Individual
DR. ROBERT S MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
127 S CAPITOL AVE, CORYDON, IN 47112-1103
(812) 738-0108
(812) 738-7758
Mailing address
127 S CAPITOL AVE, P.O BOX 387, CORYDON, IN 47112-1103
(812) 738-0108
(812) 738-7758
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009914
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200142380A
—
IN
Enumeration date
04/19/2013
Last updated
10/01/2018
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