Basic Information
Provider Information
NPI: 1033559299
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINEBERGER
FirstName: MATTHEW
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16525 HOLLY CREST LN
Address2: SUITE 250
City: HUNTERSVILLE
State: NC
PostalCode: 280784909
CountryCode: US
TelephoneNumber: 7048923300
FaxNumber: 7048923317
Practice Location
Address1: 16525 HOLLY CREST LN
Address2: SUITE 250
City: HUNTERSVILLE
State: NC
PostalCode: 280784909
CountryCode: US
TelephoneNumber: 7048923300
FaxNumber: 7048923317
Other Information
ProviderEnumerationDate: 07/02/2013
LastUpdateDate: 07/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223X0400X9421NCY Dental ProvidersDentistOrthodontics and Dentofacial Orthopedics

No ID Information.


Home