Healthcare Provider Details

I. General information

NPI: 1588622435
Provider Name (Legal Business Name): MATTHEW BURTON SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 BARONIAN CT
SOQUEL CA
95073-2959
US

IV. Provider business mailing address

369 HOUNSELL AVE STE 1
GILFORD NH
03249-6996
US

V. Phone/Fax

Practice location:
  • Phone: 831-600-8218
  • Fax:
Mailing address:
  • Phone: 603-527-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: