Individual
DR. MATTHEW KELLY KEIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3610 WESTGATE CENTER CIR, WINSTON SALEM, NC 27103-2935
(336) 768-0480
(336) 760-5525
Mailing address
3610 WESTGATE CENTER CIR, WINSTON SALEM, NC 27103-2935
(336) 768-0480
(336) 760-5525
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6236
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131195
UNITED CONCORDIA PROV #
NC
01
—
1902884943
NPI - NATIONAL PROVIDER
NC
01
—
94792
BCBS PROVIDER NUMBER
NC
Enumeration date
11/17/2006
Last updated
03/22/2012
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