Provider Demographics
NPI:1447869870
Name:ASTERS, MATTHEW CONSTANTINE (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CONSTANTINE
Last Name:ASTERS
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 1:669 OWEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-9405
Mailing Address - Country:US
Mailing Address - Phone:662-255-5587
Mailing Address - Fax:
Practice Address - Street 1:730 COULTER DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2807
Practice Address - Country:US
Practice Address - Phone:662-534-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4155-201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice