Provider Demographics
NPI:1104262005
Name:PIERCE, DENNIS MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MATTHEW
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2199
Mailing Address - Country:US
Mailing Address - Phone:812-522-8608
Mailing Address - Fax:
Practice Address - Street 1:324 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2199
Practice Address - Country:US
Practice Address - Phone:812-522-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011941A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist