Provider Demographics
NPI:1164583506
Name:MATTHEW H QUINLIVAN DDS AND ASSOCIATES
Entity Type:Organization
Organization Name:MATTHEW H QUINLIVAN DDS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:QUINLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-467-8111
Mailing Address - Street 1:149 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3332
Mailing Address - Country:US
Mailing Address - Phone:919-467-8111
Mailing Address - Fax:919-463-0105
Practice Address - Street 1:149 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3332
Practice Address - Country:US
Practice Address - Phone:919-467-8111
Practice Address - Fax:919-463-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902CVMedicaid