Provider Demographics
NPI:1043359342
Name:MATTHEWS, CORBIN (DDS)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N 700 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6993
Mailing Address - Country:US
Mailing Address - Phone:801-373-7700
Mailing Address - Fax:801-370-0762
Practice Address - Street 1:835 N 700 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6993
Practice Address - Country:US
Practice Address - Phone:801-373-7700
Practice Address - Fax:801-370-0762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372923-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice