Provider Demographics
NPI:1851592356
Name:BIRKE, MATTHEW KANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KANE
Last Name:BIRKE
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 1:176 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5132
Mailing Address - Country:US
Mailing Address - Phone:314-435-7962
Mailing Address - Fax:
Practice Address - Street 1:605 OLD BALLAS RD
Practice Address - Street 2:SUITE 118
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7000
Practice Address - Country:US
Practice Address - Phone:314-993-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070141931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice