Individual
DR. MATTHEW THERIAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
905 JACKSON ST, MACON, MO 63552-2016
(660) 385-3623
(660) 385-3526
Mailing address
905 JACKSON ST, MACON, MO 63552-2016
(660) 385-3623
(660) 385-3526
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEO 15187
MO
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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