Provider Demographics
NPI:1891218392
Name:WOLD, MATTHEW GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GARY
Last Name:WOLD
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 1:5040 E 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4468
Mailing Address - Country:US
Mailing Address - Phone:307-462-3752
Mailing Address - Fax:307-337-4929
Practice Address - Street 1:5040 E 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4468
Practice Address - Country:US
Practice Address - Phone:307-462-3752
Practice Address - Fax:307-337-4929
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty