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General NPI Number Information
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NPI Number | 1053331892
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Entity Type | Individual
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Provider Name | MATTHEW TOM RECORD DDS
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 212 S GRAND AVE
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City | GAINESVILLE
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State | TX
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Zip | 76240-5013
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Country | US
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Telephone | 940-665-4761
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Fax | 940-665-0199
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Provider Business Mailing Address
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Address Line | 212 S GRAND AVE
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City | GAINESVILLE
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State | TX
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Zip | 76240-5013
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Country | US
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Telephone | 940-665-4761
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Fax | 940-665-0199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19728
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License Number State | TX
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