Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1001979-15 | WI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 72801-20 | WI |
NPI | 1093154601 |
---|---|
Provider Name | Matthew D Reiland |
First Address | Madison, WI 53713-4248 |
Second Address | Madison, WI 53713-4248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 15/06/2020 |