Provider Demographics
NPI:1871887422
Name:KILLINGSWORTH, MATTHEW SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:KILLINGSWORTH
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 1:2125 E MAIN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5576
Mailing Address - Country:US
Mailing Address - Phone:479-231-3005
Mailing Address - Fax:479-282-0449
Practice Address - Street 1:2125 E MAIN ST STE 13
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-5576
Practice Address - Country:US
Practice Address - Phone:479-231-3005
Practice Address - Fax:479-282-0449
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3817122300000X
AR951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist