MEDICARE: DR. MATTHEW SCOTT KIRKLEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN012538	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194813030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SCOTT KIRKLEY DMD

Provider Business Mailing Address
First Line	:	2803 WRIGHTSBORO RD
Second Line	:	SUITE 25
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3913
Country	:	US
Telephone Number	:	706-733-0223
Fax Number	:	706-733-2370

Provider Business Practice Location Address
First Line	:	2803 WRIGHTSBORO RD
Second Line	:	SUITE 25
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3913
Country	:	US
Telephone Number	:	706-733-0223
Fax Number	:	706-733-2370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/09/2007

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