Provider Demographics
NPI:1336157726
Name:DENTI, MATTHEW J (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:DENTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FACILITY DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-9438
Mailing Address - Country:US
Mailing Address - Phone:828-452-5042
Mailing Address - Fax:828-452-9225
Practice Address - Street 1:35 FACILITY DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9438
Practice Address - Country:US
Practice Address - Phone:828-452-5042
Practice Address - Fax:828-452-9225
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201194207V00000X
SD9930207V00000X
NC2001-00858207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6200104000Medicaid
NC89129F4Medicaid
NC2401195AMedicare PIN
WVWV2927AMedicare PIN
WV6200104000Medicaid