MEDICARE: DR. ROBERT GENTRY MATTHEWS 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	6700	NC

General Provider Information

NPI Number	:	1902063142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GENTRY MATTHEWS D.D.S

Provider Business Mailing Address
First Line	:	1636 MEMORIAL DR
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-3518
Country	:	US
Telephone Number	:	336-227-6636
Fax Number	:	336-227-8807

Provider Business Practice Location Address
First Line	:	1636 MEMORIAL DR
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-3518
Country	:	US
Telephone Number	:	336-227-6636
Fax Number	:	336-227-8807

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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