Provider Demographics
NPI:1467412320
Name:MATHEW, JULIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
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 1:765 SMITHTOWN BYP
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5129
Mailing Address - Country:US
Mailing Address - Phone:631-724-9700
Mailing Address - Fax:
Practice Address - Street 1:765 SMITHTOWN BYP
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5129
Practice Address - Country:US
Practice Address - Phone:631-724-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050402-11223G0001X
NY050402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice