Provider Demographics
NPI:1114053956
Name:RIVARD, MATTHEW G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:RIVARD
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 1:215 S PLATTE CLAY WAY
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7592
Mailing Address - Country:US
Mailing Address - Phone:816-628-2737
Mailing Address - Fax:
Practice Address - Street 1:215 S PLATTE CLAY WAY
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7592
Practice Address - Country:US
Practice Address - Phone:816-628-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist