Provider Demographics
NPI:1164432324
Name:MATHEW, ANNIE PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:PHILIP
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 RICHMOND RUN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6413
Mailing Address - Country:US
Mailing Address - Phone:919-562-8679
Mailing Address - Fax:
Practice Address - Street 1:7780 BRIER CREEK PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7316
Practice Address - Country:US
Practice Address - Phone:919-786-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77411223G0001X
NY0450821223G0001X
NJ22DI022276001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice