Provider Demographics
NPI:1225231228
Name:MATTHEWS, CHAD ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ROBERT
Last Name:MATTHEWS
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 1:1033 BAYSHORE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1569
Mailing Address - Country:US
Mailing Address - Phone:803-327-4444
Mailing Address - Fax:803-327-4443
Practice Address - Street 1:1033 BAYSHORE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1569
Practice Address - Country:US
Practice Address - Phone:803-327-4444
Practice Address - Fax:803-327-4443
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0225001223P0300X
SC46671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics