MEDICARE: DR. MATTHEW W PLUMMER JR. DMD MPH

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	10664	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	737261	OTHER		UNITED CONCORDIA
2	82D111	OTHER		BCBS

General Provider Information

NPI Number	:	1396965612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW W PLUMMER JR. DMD MPH

Provider Business Mailing Address
First Line	:	2101 CRAWFORD ST
Second Line	:	STE 302
City	:	HOUSTON
State	:	TX
Zip	:	77002-8941
Country	:	US
Telephone Number	:	713-757-1948
Fax Number	:	713-757-9835

Provider Business Practice Location Address
First Line	:	5009 CAROLINE ST STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5750
Country	:	US
Telephone Number	:	713-757-1948
Fax Number	:	713-757-9835

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/26/2019

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