Healthcare Provider Details

I. General information

NPI: 1457030447
Provider Name (Legal Business Name): MATTHEW GARTNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/01/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 BOULEVARD DE FRANCE MCRD
PARRIS ISLAND SC
29905
US

IV. Provider business mailing address

834 SOLOMON DR
JACKSONVILLE NC
28546-8454
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-3500
  • Fax:
Mailing address:
  • Phone: 386-864-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: