Provider Demographics
NPI:1063506624
Name:MATHEW, SHIRLEY E (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:E
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HEBRON PKWY
Mailing Address - Street 2:SUITE 902
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5003
Mailing Address - Country:US
Mailing Address - Phone:972-459-1100
Mailing Address - Fax:469-675-6495
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:SUITE 902
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5003
Practice Address - Country:US
Practice Address - Phone:972-459-1100
Practice Address - Fax:469-675-6495
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice