Provider Demographics
NPI:1750823118
Name:SCOTT B MATTHEWS DDS PA
Entity Type:Organization
Organization Name:SCOTT B MATTHEWS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BUTLER
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-522-4035
Mailing Address - Street 1:306 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1630
Mailing Address - Country:US
Mailing Address - Phone:252-522-4035
Mailing Address - Fax:252-522-4797
Practice Address - Street 1:306 DARBY AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1630
Practice Address - Country:US
Practice Address - Phone:252-522-4035
Practice Address - Fax:252-522-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty