Provider Demographics
NPI:1669736385
Name:MACGINNIS, MATTHEW (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MACGINNIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 N GLEN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2101
Mailing Address - Country:US
Mailing Address - Phone:714-345-4602
Mailing Address - Fax:
Practice Address - Street 1:333 W BASTANCHURY RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3433
Practice Address - Country:US
Practice Address - Phone:714-253-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics