Provider Demographics
NPI:1033127063
Name:CHURCH, MATTHEW E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:CHURCH
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 1:10935 E WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3182
Mailing Address - Country:US
Mailing Address - Phone:317-890-4455
Mailing Address - Fax:317-890-4460
Practice Address - Street 1:10935 E WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3182
Practice Address - Country:US
Practice Address - Phone:317-890-4455
Practice Address - Fax:317-890-4460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12010045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist