Provider Demographics
NPI:1598830523
Name:MCGUIRE, MATTHEW T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:MCGUIRE
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 1:4022 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3922
Mailing Address - Country:US
Mailing Address - Phone:402-573-9442
Mailing Address - Fax:
Practice Address - Street 1:2623 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-7013
Practice Address - Country:US
Practice Address - Phone:402-553-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11365279900Medicaid