Agnew, Matt R
Agnew, Matt R is an individual health care provider with primary practice located at 1270 W Main St , Sun Prairie WI 53590-1930. He recently has only one registered license in Dental Providers / Dental Public Health, which is considered as his primary health care specialty. Agnew, Matt R can be contacted via phone (608) 443-5482.Contact Information
Primary practice address
1270 W Main St
Sun Prairie WI 53590-1930
Phone: (608) 443-5482
Fax: (608) 837-9134
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Public Health | 1223D0001X | 6179-15 | Wisconsin |
Profile Details
| NPI number | 1295916419 |
|---|---|
| LBN Legal business name | Agnew, Matt R |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 15th, 2007 |
| Last updated | May 4th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295916419 | NPPES |
| Wisconsin | MEDICAID | 33815700 |
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