Provider Demographics
NPI:1831268507
Name:GORHAM, MATT J III (DDS)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:J
Last Name:GORHAM
Suffix:III
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 30TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1308
Mailing Address - Country:US
Mailing Address - Phone:615-327-4914
Mailing Address - Fax:615-327-3892
Practice Address - Street 1:124 30TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1308
Practice Address - Country:US
Practice Address - Phone:615-327-4914
Practice Address - Fax:615-327-3892
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice