Provider Demographics
NPI:1053330696
Name:DUNFORD, R MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:MATTHEW
Last Name:DUNFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 CASCADE TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9500
Mailing Address - Country:US
Mailing Address - Phone:770-205-2150
Mailing Address - Fax:
Practice Address - Street 1:5790 CASCADE TRL
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9500
Practice Address - Country:US
Practice Address - Phone:770-205-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice