Provider Demographics
NPI:1477660025
Name:MARTIN, MATTHEW BURGESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BURGESS
Last Name:MARTIN
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 1:720 RIVER DR S STE 200
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-1840
Mailing Address - Country:US
Mailing Address - Phone:406-452-2138
Mailing Address - Fax:406-453-6205
Practice Address - Street 1:720 RIVER DR S STE 200
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1840
Practice Address - Country:US
Practice Address - Phone:406-452-2138
Practice Address - Fax:406-453-6205
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22501223G0001X
IDD36261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice