Provider Demographics
NPI:1679206684
Name:WOOLCOCK, MATTHEW WAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WAYNE
Last Name:WOOLCOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18407-3526
Mailing Address - Country:US
Mailing Address - Phone:570-282-5189
Mailing Address - Fax:
Practice Address - Street 1:127 ROUTE 106
Practice Address - Street 2:
Practice Address - City:GREENFIELD TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18407-3526
Practice Address - Country:US
Practice Address - Phone:570-282-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0437721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice