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General NPI Number Information
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NPI Number | 1972006682
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Entity Type | Organization
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Legal Business Name | MUNDO DENTAL GROUP, PA
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 3463 HIGHWAY 21 BYP STE 101
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City | FORT MILL
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State | SC
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Zip | 29715-7210
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Country | US
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Telephone | 704-825-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 3463 HIGHWAY 21 BYP STE 101
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City | FORT MILL
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State | SC
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Zip | 29715-7210
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Country | US
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Telephone | 704-825-2081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW MICHAEL HOWELL
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Credential | DDS
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Telephone | 704-825-2081
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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 |
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License Number State |
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