Provider Demographics
NPI:1013529296
Name:FAY, MATTHEW B (DDS, MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:FAY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DOWNTOWNER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5401
Mailing Address - Country:US
Mailing Address - Phone:251-471-3381
Mailing Address - Fax:251-471-3383
Practice Address - Street 1:715 DOWNTOWNER BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5401
Practice Address - Country:US
Practice Address - Phone:251-471-3381
Practice Address - Fax:251-471-3383
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN25227204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery