Active NPI
Matthew Ryan Gillham, DDS
- Pediatric Dentistry
- Temple, TX
National Provider Identifier
1790896512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 23162
- Practice address
- 2122 Birdcreek Dr
Temple, TX 76502-1034 - Phone
- (254) 771-5701
- NPI assigned
- Aug 31, 2006
- Last updated
- Sep 8, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 23162 | TX | Primary |
Addresses
Primary practice location
2122 Birdcreek Dr
Temple, TX 76502-1034
Mailing address
PO Box 170729
Austin, TX 78717-0034
Phone (254) 771-5701
Other practice location 1
1121 Lake Air Dr
Waco, TX 76710-4417
Phone (254) 772-8330
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 |
|---|---|---|---|
| 23162 | TX | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ac Dentistry PLLC | Dentist | Past | Accepting new patients |
| Temple Kids Dental | Dentist | Past | Accepting new patients |
| Joseph R. Raub, Jr., D.M.D., M.SC.D., P.a. | Pediatric Dentistry | Past | Accepting new patients |
| Waco Kids Dental PC | Pediatric Dentistry | Past | Accepting new patients |
| Bop Dental Specialists | Past | Accepting new patients |
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Austin, TX
- NPI 1003462045
-
- Pediatric Dentistry
- Temple, TX
- NPI 1588783880
-
- Dentist
- Temple, TX
- NPI 1568907269
-
- Pediatric Dentistry
- Waco, TX
- NPI 1598041659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788825600000",
"number": "1790896512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 170729",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787170034",
"telephone_number": "254-771-5701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2122 BIRDCREEK DR",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765021034",
"telephone_number": "254-771-5701"
}
],
"practiceLocations": [
{
"address_1": "1121 Lake Air Dr",
"address_purpose": "LOCATION",
"city": "Waco",
"state": "TX",
"postal_code": "767104417",
"country_code": "US",
"telephone_number": "254-772-8330",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GILLHAM",
"first_name": "MATTHEW",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "23162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temple, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.