MEDICARE: MATTHEW J. MCCAIN DMD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	6027	AL

General Provider Information

NPI Number	:	1154720571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW J. MCCAIN DMD, LLC

Provider Business Mailing Address
First Line	:	285 SILVER CREEK PKWY
Second Line	:
City	:	ALABASTER
State	:	AL
Zip	:	35007-7542
Country	:	US
Telephone Number	:	205-960-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 7TH ST S
Second Line	:	SUITE 300
City	:	CLANTON
State	:	AL
Zip	:	35045-3778
Country	:	US
Telephone Number	:	205-960-0640
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENSTIST
Name	:	DR. MATTHEW JOHNSON MCCAIN
Credential	:	DMD
Telephone Number	:	205-960-0640

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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