Provider Demographics
NPI:1992996508
Name:MULCAHY, MATTHEW TERRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TERRENCE
Last Name:MULCAHY
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 1:9 AMELIA DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554
Mailing Address - Country:US
Mailing Address - Phone:508-228-4500
Mailing Address - Fax:508-228-4585
Practice Address - Street 1:9 AMELIA DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554
Practice Address - Country:US
Practice Address - Phone:508-228-4500
Practice Address - Fax:508-228-4500
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice