Provider Demographics
NPI:1548999394
Name:AMANN, MATTHEW RAFAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAFAEL
Last Name:AMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OXMOOR RDG
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6034
Mailing Address - Country:US
Mailing Address - Phone:662-891-0911
Mailing Address - Fax:
Practice Address - Street 1:167 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3011
Practice Address - Country:US
Practice Address - Phone:662-561-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4284-221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice