NPI 1104239136

Matthew Gregory Boothe, DDS

Practitioner Pediatric Dentistry Wasilla, AK

Practice location

Address: 3470 E Meridian Park Loop, Wasilla, AK 99654-7294
Phone: (907) 373-8684
Mailing address: 2924 E Odsather Cir, Wasilla, AK 99654-7294

Registered specialties (2)

Pediatric Dentistry Primary

Dental Providers Taxonomy 1223P0221X Licence 109471 (AK)

Other Dentist providers in Alaska →

General Practice Dentistry

Dental Providers Taxonomy 1223G0001X Licence 30627 (TX)

Registry record

NPI: 1104239136
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Jun 2014
Record last updated: 2 Sep 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.