MEDICARE: DR. MATTHEW TODD GUNNELL D.D.S

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	122300000X	Dentist	D008457	AZ

General Provider Information

NPI Number	:	1558616987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW TODD GUNNELL D.D.S

Provider Business Mailing Address
First Line	:	4 MARKET ST STE 4202
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-5641
Country	:	US
Telephone Number	:	828-884-3702
Fax Number	:	828-877-4065

Provider Business Practice Location Address
First Line	:	4 MARKET ST STE 4202
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-5641
Country	:	US
Telephone Number	:	828-884-3702
Fax Number	:	828-877-4065

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	03/21/2017

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