Provider Demographics
NPI:1003222761
Name:CARRAWAY, MATTHEW DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:CARRAWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N GRANT AVE STE 105B
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4054
Mailing Address - Country:US
Mailing Address - Phone:432-699-2044
Mailing Address - Fax:432-205-0007
Practice Address - Street 1:901 N GRANT AVE STE 105B
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4054
Practice Address - Country:US
Practice Address - Phone:432-699-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry