Healthcare Provider Details

I. General information

NPI: 1275705097
Provider Name (Legal Business Name): MATTHEW MCNUTT, DDS, MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TEW CT SUITE 108
CLAYTON NC
27520-2279
US

IV. Provider business mailing address

109 RICHELIEU DR
CARY NC
27518-8634
US

V. Phone/Fax

Practice location:
  • Phone: 919-451-3704
  • Fax:
Mailing address:
  • Phone: 919-451-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7787
License Number StateNC

VIII. Authorized Official

Name: MATTHEW D MCNUTT
Title or Position: ORTHODONTIST
Credential:
Phone: 919-451-3704