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DWAIN E MATELSKI DDS PERIODONTIST
NPI 1154544740
Dentist - Periodontics in Fort Worth, TX

Active since April 11, 2007
1124 S LAKE STREET, SUITE B, FORT WORTH, TX 76104(817) 336-1166(817) 336-1180 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dwain E Matelski Dds Periodontist NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DWAIN E MATELSKI DDS PERIODONTIST (NPI 1154544740) is a healthcare organization registered as a periodontics in Fort Worth, Texas and active in the NPI registry since April 2007. The organization lists Dwain Edwin Matelski, President, as its authorized official.

NPPES Registry Identity

NPI1154544740
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameSOUTHLAKE DENTAL CORP
Location Address1124 S LAKE STREET, SUITE BFort Worth, TX 76104
Mailing Address1124 S Lake Street, Suite BFort Worth, TX 76104 · (817) 336-1166 · Fax (817) 336-1180
Phone(817) 336-1166
Fax(817) 336-1180
Organization SubpartNo
Authorized OfficialDwain Edwin MatelskiPresident · (817) 336-1166
Enumeration DateApril 11, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1154544740 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in TX · 9930
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
1124 S LAKE STREET, Fort Worth, TX 76104
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Other Names 1

Other NameDwain E Matelski Dds Periodontist

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Dental Corp's NPI number?

The NPI number for Southlake Dental Corp is 1154544740. It was assigned to this organization in the NPPES registry on April 11, 2007. The provider is also known as Dwain E Matelski Dds Periodontist.

Where is Southlake Dental Corp located?

Southlake Dental Corp is located at 1124 S Lake Street Suite B, Fort Worth, TX 76104. The listed phone number is (817) 336-1166.

What is Southlake Dental Corp's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Southlake Dental Corp was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.