Provider Demographics
NPI:1396965612
Name:PLUMMER, MATTHEW W JR (DMD MPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:PLUMMER
Suffix:JR
Gender:M
Credentials:DMD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CRAWFORD ST
Mailing Address - Street 2:STE 302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8941
Mailing Address - Country:US
Mailing Address - Phone:713-757-1948
Mailing Address - Fax:713-757-9835
Practice Address - Street 1:5009 CAROLINE ST STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5750
Practice Address - Country:US
Practice Address - Phone:713-757-1948
Practice Address - Fax:713-757-9835
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
737261OtherUNITED CONCORDIA
82D111OtherBCBS