Provider Demographics
NPI:1073534475
Name:MATTHEWS, SCOTT BUTLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BUTLER
Last Name:MATTHEWS
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 1:306 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1630
Mailing Address - Country:US
Mailing Address - Phone:252-522-4035
Mailing Address - Fax:
Practice Address - Street 1:306 DARBY AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1630
Practice Address - Country:US
Practice Address - Phone:252-522-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990051Medicaid
NY90051OtherBLUE CROSS/BLUE SHIELD
NC66770Medicare UPIN