Provider Demographics
NPI:1356851141
Name:MATHEW, GEORGE CHERUKARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHERUKARA
Last Name:MATHEW
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 1:239 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6831
Mailing Address - Country:US
Mailing Address - Phone:412-953-0969
Mailing Address - Fax:
Practice Address - Street 1:239 WASHINGTON ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6831
Practice Address - Country:US
Practice Address - Phone:412-953-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty