MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC. (NPI# 1679096523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679096523 |
| Entity Type | Organization |
| Organization Name | MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC. |
| Other Organization Name | LAKEVIEW DENTAL |
| Practice Address |
801 W Milwaukee Dr Coeur D Alene ID 83814-2236 |
| Practice Telephone | (208) 664-0884 |
| Mailing Telephone | 2086640884 |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |
| Authorized Official Name | DR. ALVIN BRETT MATTESON (OWNER/ PROSTHODONTIST) |
| Authorized Official Telephone | 2708532508 |
| Authorized Official Credential | DDS, FACP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | D-4027 | ID | Dental Providers |
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
D-4027 | ID | Dental Providers |
| Other Name | Type Code |
|---|---|
| Lakeview Dental | Doing Business As Name - Organization |
| Street Address |
801 W MILWAUKEE DR |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-2236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629143748 | James Lee Landers | Dentist | 801 W Milwaukee Dr, Coeur D Alene, ID 83814-2236 | 2006-11-22 |
| 1801241922 | Lakeview Dental | Durable Medical Equipment & Medical Supplies | 801 W Milwaukee Dr, Coeur D Alene, ID 83814-2236 | 2016-04-26 |
| 1356654172 | Spencer C Wirig, Dmd, Inc | Dentist | 801 W Milwaukee Dr, Coeur D Alene, ID 83814-2236 | 2010-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275736522 | Idaho Prosthodontics | Dentist | 347 Crooked Ear Ct, Sandpoint, ID 83864-9477 | 2007-06-06 |
| 1043221393 | Linda Jean Ruppel | Dentist | 7669 Emerald St, Boise, ID 83704-9018 | 2006-08-11 |
| 1790049286 | Michael Lynn Gurney | Dentist | 1000 N Curtis Rd, Suite 203, Boise, ID 83706-1337 | 2012-06-28 |
| 1740511344 | Robert Schroetlin | Dentist | 1215 E 6th St, Moscow, ID 83843-3705 | 2010-01-20 |
| 1710147087 | Darrel and Roseann Mooney | Dentist | 1323 Michigan St, Sandpoint, ID 83864-1747 | 2008-06-11 |
| 1144232869 | Darrel L Mooney | Dentist | 314 W Bannock St, Boise, ID 83702-6032 | 2006-08-12 |
| 1578588364 | Braden M Stauts | Dentist | 1000 N Curtis Rd, Suite 203, Boise, ID 83706-1337 | 2006-07-13 |
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on MATTESON IMPLANT AND RECONSTRUCTIVE DENTISTRY PC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.