Provider Demographics
NPI:1124506340
Name:WAITE, MATTHEW DANIEL (DDS, MPH, MSD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:WAITE
Suffix:
Gender:
Credentials:DDS, MPH, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 SUNSET OFFICE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1021
Mailing Address - Country:US
Mailing Address - Phone:314-956-0528
Mailing Address - Fax:
Practice Address - Street 1:3555 SUNSET OFFICE DR STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1021
Practice Address - Country:US
Practice Address - Phone:314-956-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist