Organization
PROFESSIONAL DENTAL ASSOCIATES PC
Active
Other names
Jensen Shroyer Anderson PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN T MATHEWSON DDS (DENTIST OWNER)
(989) 382-7227
Entity
Organization
Contact information
Practice address
98 NORTHERN AVENUE, BARRYTON, MI 49305
(989) 382-7227
(989) 382-7227
Mailing address
98 NORTHERN AVENUE, PO BOX 244, BARRYTON, MI 49305
(989) 382-7227
(989) 382-7227
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10102
MI
1223G0001X
General Practice Dentistry
16945
MI
1223G0001X
General Practice Dentistry
19296
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8012370
BC BS
MI
Enumeration date
02/29/2008
Last updated
02/29/2008
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