Provider Demographics
NPI:1760823793
Name:MCCAIN, MATTHEW JOHNSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHNSON
Last Name:MCCAIN
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 1:285 SILVER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-7542
Mailing Address - Country:US
Mailing Address - Phone:205-663-8634
Mailing Address - Fax:
Practice Address - Street 1:230 E 10TH ST STE 106
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5771
Practice Address - Country:US
Practice Address - Phone:256-741-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist