Matthew Bridwell, D.D.S.
Individual provider Active NPI General Practice Dentistry · Sheridan, AR
NPI 1407086366 · NPPES record last updated Sep 19, 2012
Key facts
- NPI
- 1407086366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3727 (AR)
- Practice address
- 1310 S Rock St Ste 1
Sheridan, AR 72150-7223 - Phone
- (870) 942-4444
- Fax
- (870) 942-4454
- NPI assigned
- Jul 24, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170330000854 | AR | Order and Referring Only - Dentist |
1951695998 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3727 | AR | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3727 | AR | Yes |
Addresses
Primary practice location
1310 S Rock St Ste 1
Sheridan, AR 72150-7223
Mailing address
1310 S Rock St Ste 1
Sheridan, AR 72150-7223
Phone (870) 942-4444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 179075608 | Medicaid | AR |
Other providers in Sheridan, AR
- Blayne Ellis Beene
- Bethel Burris Oliver PLLC
- BHC Pinnacle Pointe Hospital
- Kayla Blocker
- Jennifer Lynn Bradshaw
- Iyanna Denise Brown
- Carol D Campbell
- Carol D Campbell Inc
- Morgan Elizabeth Carter
- Carrie Marie Clay
All providers in Sheridan, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.