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General NPI Number Information
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NPI Number | 1104120286
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Entity Type | Individual
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Provider Name | MATTHEW GERALD DDS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 2573 CHAIN BRIDGE RD
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City | VIENNA
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State | VA
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Zip | 22181-5576
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Country | US
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Telephone | 703-281-0855
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Fax | 703-281-0088
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Provider Business Mailing Address
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Address Line | 2573 CHAIN BRIDGE RD
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City | VIENNA
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State | VA
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Zip | 22181-5576
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Country | US
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Telephone | 703-281-0855
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Fax | 703-281-0088
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412891
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License Number State | VA
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