Basic Information
| Provider Information | |||||||||
| NPI: | 1417295379 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MATTHEW LINEBERGER D.D.S. P.A. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LINEBERGER ORTHODONTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9625 NORTHCROSS CENTER CT | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048923300 | ||||||||
| FaxNumber: | 7048923317 | ||||||||
| Practice Location | |||||||||
| Address1: | 9625 NORTHCROSS CENTER COURT | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280789998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048923300 | ||||||||
| FaxNumber: | 7048923317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2013 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LINEBERGER | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | WOODSIDE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6168864436 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.D.S., M.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 9421 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.