Provider Demographics
NPI:1437213311
Name:MATHEWS, DONALD KENNETH (LD DPD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KENNETH
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:LD DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E WISHKAH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4133
Mailing Address - Country:US
Mailing Address - Phone:360-538-0060
Mailing Address - Fax:
Practice Address - Street 1:404 E WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4133
Practice Address - Country:US
Practice Address - Phone:360-538-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000135122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist