Provider Demographics
NPI:1225325558
Name:MATHESON, TODD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:L
Last Name:MATHESON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 S LEWIS WAY
Mailing Address - Street 2:SUITE 3-C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2292
Mailing Address - Country:US
Mailing Address - Phone:303-985-8000
Mailing Address - Fax:
Practice Address - Street 1:2598 S LEWIS WAY
Practice Address - Street 2:SUITE 3-C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2292
Practice Address - Country:US
Practice Address - Phone:208-351-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice