Matthew Theriac, D.d.s. Llc

Specialty details in registry · Macon, MO

Call (660) 385-3623 Directions

At a glance

905 Jackson St, Macon, MO 63552-2016

NPPES record updated Sep 26, 2007. Public records can lag behind changes at a practice.

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Practice location

905 Jackson St
Macon, MO 63552-2016

Professional details: NPI, taxonomy & registry record

NPI1760679401

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 302R00000X
Enumeration date: Sep 26, 2007
Record updated: Sep 26, 2007

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

302R00000X · Primary

License reported: 15187 MO

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

905 Jackson St
Macon, MO 63552-2016

Phone: (660) 385-3623

Mailing address

905 JACKSON ST

MACON, MO 635522016

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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