Provider Demographics
NPI:1306985528
Name:MATLOCK, ROBERT JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:MATLOCK
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 1:900 W HOUSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-3941
Mailing Address - Country:US
Mailing Address - Phone:903-935-7031
Mailing Address - Fax:903-935-3885
Practice Address - Street 1:900 W HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3941
Practice Address - Country:US
Practice Address - Phone:903-935-7031
Practice Address - Fax:903-935-3885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008425301Medicaid