Provider Demographics
NPI:1093332017
Name:SMITH, MATTHEW CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CRAIG
Last Name:SMITH
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 1:7033 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-9031
Mailing Address - Country:US
Mailing Address - Phone:252-561-6942
Mailing Address - Fax:
Practice Address - Street 1:7033 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-9031
Practice Address - Country:US
Practice Address - Phone:252-561-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist