Provider Demographics
NPI:1558616987
Name:GUNNELL, MATTHEW TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TODD
Last Name:GUNNELL
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 1:4 MARKET ST STE 4202
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-5641
Mailing Address - Country:US
Mailing Address - Phone:828-884-3702
Mailing Address - Fax:828-877-4065
Practice Address - Street 1:4 MARKET ST STE 4202
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-5641
Practice Address - Country:US
Practice Address - Phone:828-884-3702
Practice Address - Fax:828-877-4065
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist