Provider Demographics
NPI:1285083527
Name:MATTOX, DEXTER WITHERINGTON (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:WITHERINGTON
Last Name:MATTOX
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0514
Mailing Address - Country:US
Mailing Address - Phone:912-266-8100
Mailing Address - Fax:912-266-8125
Practice Address - Street 1:149 SCRANTON CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0514
Practice Address - Country:US
Practice Address - Phone:912-266-8100
Practice Address - Fax:912-266-8125
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0152161223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty