Provider Demographics
NPI:1447639232
Name:AITKEN, MATTHEW J (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:AITKEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 W 29TH ST
Mailing Address - Street 2:P O BOX 986
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-9668
Mailing Address - Country:US
Mailing Address - Phone:402-494-5445
Mailing Address - Fax:402-494-7630
Practice Address - Street 1:1509 W 29TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-9668
Practice Address - Country:US
Practice Address - Phone:402-494-5445
Practice Address - Fax:402-494-7630
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist