Provider Demographics
NPI:1518169820
Name:MATHIAS, RANA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANA
Middle Name:LYNN
Last Name:MATHIAS
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 1:756 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-6601
Mailing Address - Country:US
Mailing Address - Phone:717-569-2060
Mailing Address - Fax:
Practice Address - Street 1:420 E PARK ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2267
Practice Address - Country:US
Practice Address - Phone:717-367-2423
Practice Address - Fax:717-367-9664
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031278L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011644380001Medicaid