Provider Demographics
NPI:1710991930
Name:CHRISTOPHER, MATTHEW CORBETT (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CORBETT
Last Name:CHRISTOPHER
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 1:715 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1100
Mailing Address - Country:US
Mailing Address - Phone:517-741-4565
Mailing Address - Fax:517-741-8912
Practice Address - Street 1:715 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1100
Practice Address - Country:US
Practice Address - Phone:517-741-4565
Practice Address - Fax:517-741-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15981991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice