Provider Demographics
NPI:1972512713
Name:ANKRUM, MATTHEW TODD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TODD
Last Name:ANKRUM
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:3708 S MAIN ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE H
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7007
Mailing Address - Country:US
Mailing Address - Phone:540-552-1100
Mailing Address - Fax:540-552-6900
Practice Address - Street 1:3708 S MAIN ST
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE H
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7007
Practice Address - Country:US
Practice Address - Phone:540-552-1100
Practice Address - Fax:540-552-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010088781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics