Provider Demographics
NPI:1639464795
Name:ESTES, MATTHEW R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:ESTES
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 1:6025 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2160
Mailing Address - Country:US
Mailing Address - Phone:804-739-7391
Mailing Address - Fax:
Practice Address - Street 1:6025 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2160
Practice Address - Country:US
Practice Address - Phone:804-739-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice