Provider Demographics
NPI:1629097928
Name:WAITE, MATTHEW THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:WAITE
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 1:17 DAVIS BOULEVARD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:813-344-4867
Mailing Address - Fax:813-902-6185
Practice Address - Street 1:17 DAVIS BOULEVARD
Practice Address - Street 2:SUITE 305
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-344-4867
Practice Address - Fax:813-902-6185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 177171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice