Individual
DR. MARK JAMES MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
214 LARKIN ST, TOMAH, WI 54660-0606
(608) 372-3298
(608) 372-3128
Mailing address
PO BOX 606, 214 LARKIN ST, TOMAH, WI 54660-0606
(608) 372-3298
(608) 372-3128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2482
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
811742
UNITED CONCORDIA INS CO
—
Enumeration date
08/21/2006
Last updated
06/25/2013
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