Provider Demographics
NPI:1679532550
Name:BRONK, MATTHEW JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BRONK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:JAMES
Other - Last Name:BRONK, DMD PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PA
Mailing Address - Street 1:2218 RUTHERFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5368
Mailing Address - Country:US
Mailing Address - Phone:828-652-7341
Mailing Address - Fax:828-252-6272
Practice Address - Street 1:2218 RUTHERFORD RD STE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-652-7341
Practice Address - Fax:828-288-6272
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33921223S0112X
NC102251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery