Dr. Matthew Gregory Boothe
Pediatric Dentist Dentist - General Practice
3470 E Meridian Park Loop
Wasilla
, Alaska 99654-7294
Dr. Matthew Gregory Boothe
Pediatric Dentist Dentist - General Practice
3470 E Meridian Park Loop
Wasilla
, Alaska 99654-7294
(210) 710-9296
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About
Features
Specialties
- General Practice
- Pediatric Dentist
Languages spoken
- English
Location
First Address
- Dr. Matthew Gregory Boothe
- 2924 E Odsather Cir
- Wasilla, AK
- Zip : 99654-7294
- Phone : (210) 710-9296
Second Address
- Dr. Matthew Gregory Boothe
- 3470 E Meridian Park Loop
- Wasilla, AK
- Zip : 99654-7294
- Phone : (907) 373-8684
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 1223G0001X | General Practice | 30627 | TX |
| N | 213EG0000X | General Practice | 30627 | TX |
| Y | 1223P0221X | Pediatric Dentist | 109471 | AK |
National Provider Identifier
| NPI | 1104239136 |
|---|---|
| Provider Name | Dr. Matthew Gregory Boothe |
| First Address | Wasilla, AK 99654-7294 |
| Second Address | Wasilla, AK 99654-7294 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/06/2014 |
| Last Update Date | 02/09/2016 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.