Provider Demographics
NPI:1669673703
Name:BORDERS, MATTHEW WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:BORDERS
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 1:222 N LAFAYETTE ST
Mailing Address - Street 2:1ST FLOOR SUITE 13
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4444
Mailing Address - Country:US
Mailing Address - Phone:704-487-8931
Mailing Address - Fax:704-487-8332
Practice Address - Street 1:222 N LAFAYETTE ST
Practice Address - Street 2:1ST FLOOR SUITE 13
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4444
Practice Address - Country:US
Practice Address - Phone:704-487-8931
Practice Address - Fax:704-487-8332
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice