Provider Demographics
NPI:1407178981
Name:MATHEW, INDHU (DDS)
Entity Type:Individual
Prefix:DR
First Name:INDHU
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1404
Mailing Address - Country:US
Mailing Address - Phone:516-579-0330
Mailing Address - Fax:516-977-9679
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 111
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-579-0330
Practice Address - Fax:516-977-9679
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice