Provider Demographics
NPI:1902884943
Name:DR MATTHEW K KEIDER DDS PA
Entity type:Organization
Organization Name:DR MATTHEW K KEIDER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-768-0480
Mailing Address - Street 1:3610 WESTGATE CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2935
Mailing Address - Country:US
Mailing Address - Phone:336-768-0480
Mailing Address - Fax:336-760-5525
Practice Address - Street 1:3610 WESTGATE CENTER CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2935
Practice Address - Country:US
Practice Address - Phone:336-768-0480
Practice Address - Fax:336-760-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6236261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental