Provider Demographics
NPI:1376742353
Name:MATHEW, REJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:REJI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W MCDERMOTT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3096
Mailing Address - Country:US
Mailing Address - Phone:469-675-3890
Mailing Address - Fax:
Practice Address - Street 1:1511 W MCDERMOTT DR STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3096
Practice Address - Country:US
Practice Address - Phone:469-675-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice