Active NPI
Matthew Pham
- Dentist
- North Wilkesboro, NC
National Provider Identifier
1033893136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13295
- Practice address
- 1915 W Park Dr
North Wilkesboro, NC 28659-3511 - Phone
- (336) 903-9399
- NPI assigned
- Jun 12, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 113015 | CA | |
| Dentist | 122300000X | 13295 | NC | Primary |
Addresses
Primary practice location
1915 W Park Dr
North Wilkesboro, NC 28659-3511
Mailing address
1915 W Park Dr
North Wilkesboro, NC 28659-3511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13295 | NC | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781136000000",
"number": "1033893136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1915 W PARK DR",
"city": "NORTH WILKESBORO",
"state": "NC",
"postal_code": "286593511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 W PARK DR",
"city": "NORTH WILKESBORO",
"state": "NC",
"postal_code": "286593511",
"telephone_number": "336-903-9399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-12",
"last_updated": "2026-06-11",
"certification_date": "2026-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "113015",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "13295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Wilkesboro, NC
- Paragon Outpatient Rehabilitation Services, LLC
- Danny J Payne, OD
- Samuel Sparrow Pendergraft, PHD, PA-C
- Joel Laron Perkins, BA/QP
- Sarah Peters, MD
- Phillip Marvin Brame DDS Ms PA
- Charles Henry Phillips III, P.A.
- Tate Johnathan Phillips, PA
- Physical Therapy Associates of Wilkes LLC
- Piedmont Stone Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.