MEDICARE: DR. MATTHEW BRYAN PALOMAKI DDS

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	8672	TN
2	1223G0001X	General Practice Dentistry	8672	TN

General Provider Information

NPI Number	:	1578768354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW BRYAN PALOMAKI DDS

Provider Business Mailing Address
First Line	:	2485 FORT CAMPBELL BLVD
Second Line	:	STE 101
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042
Country	:	US
Telephone Number	:	931-431-0200
Fax Number	:	931-431-3022

Provider Business Practice Location Address
First Line	:	2485 FORT CAMPBELL BLVD
Second Line	:	STE 101
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042
Country	:	US
Telephone Number	:	931-431-0200
Fax Number	:	931-431-3022

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	03/31/2016

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