=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669034864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW G CORBIN, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2019
-----------------------------------------------------
Last Update Date | 07/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 W PALMER ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28734-0431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-524-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28744-0100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-342-8076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW G CORBIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 828-342-8076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------