Provider Demographics
NPI:1871682690
Name:GEMP, MATTHEW DENNIS (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DENNIS
Last Name:GEMP
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 1:2425 WEST LOOP S
Mailing Address - Street 2:STE 333
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4205
Mailing Address - Country:US
Mailing Address - Phone:713-960-9623
Mailing Address - Fax:713-960-8682
Practice Address - Street 1:2425 WEST LOOP S
Practice Address - Street 2:STE 333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4205
Practice Address - Country:US
Practice Address - Phone:713-960-9623
Practice Address - Fax:713-960-8682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154161223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760457104OtherIRS TIN