1710922810 NPI number — ROBERT J. MATTHEWS DMD PLLC

Table of content: MRS. SAMANTHA JO HARMS APRN (NPI 1902248115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710922810 NPI number — ROBERT J. MATTHEWS DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT J. MATTHEWS DMD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710922810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12801 W BELL RD
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-9797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-972-1200
Provider Business Mailing Address Fax Number:
623-972-3405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12801 W BELL RD
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-972-1200
Provider Business Practice Location Address Fax Number:
623-972-3405
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTHEWS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
623-972-1200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5258 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 862880 . This is a "ACCCHS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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