Provider Demographics
NPI:1588622435
Name:SMITH, MATTHEW BURTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BURTON
Last Name:SMITH
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 1:369 HOUNSELL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6996
Mailing Address - Country:US
Mailing Address - Phone:603-527-2500
Mailing Address - Fax:
Practice Address - Street 1:3018 BARONIAN CT
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2959
Practice Address - Country:US
Practice Address - Phone:831-600-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist