Provider Demographics
NPI:1912298738
Name:MATTHEWS, BRIAN THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 DELAWARE AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-416-2024
Mailing Address - Fax:
Practice Address - Street 1:1403 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4434
Practice Address - Country:US
Practice Address - Phone:302-475-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG-0001315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist