Individual
DR. KEVIN TODD MATHEWSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
415 SOUTH STATE STREET, BIG RAPIDS, MI 49307-2049
(231) 796-3571
(231) 796-2211
Mailing address
415 SOUTH STATE STREET, BIG RAPIDS, MI 49307-2049
(231) 796-3571
(231) 796-2211
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
29010-16945
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3272864
—
MI
01
—
3317643
MEDICAID
MI
01
—
971753
UNITED CONCORDIA
MI
01
—
D169450
BCBS
MI
Enumeration date
11/22/2006
Last updated
07/08/2007
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