Provider Demographics
NPI:1508909706
Name:NUNEZ, MATTHEW GARCIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GARCIA
Last Name:NUNEZ
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 1:106 RAILROAD ST
Mailing Address - Street 2:BLDG. 2 SUITE 3
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2320
Mailing Address - Country:US
Mailing Address - Phone:606-573-9944
Mailing Address - Fax:606-573-9995
Practice Address - Street 1:106 RAILROAD ST
Practice Address - Street 2:BLDG. 2 SUITE 3
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2320
Practice Address - Country:US
Practice Address - Phone:606-573-9944
Practice Address - Fax:606-573-9995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60073095Medicaid