Provider Demographics
NPI:1528230935
Name:VIJAY A. MATHURA DDS PA
Entity Type:Organization
Organization Name:VIJAY A. MATHURA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-747-0341
Mailing Address - Street 1:4 W ROLLING CROSSROADS REAR 5
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6278
Mailing Address - Country:US
Mailing Address - Phone:410-747-0341
Mailing Address - Fax:
Practice Address - Street 1:4 W ROLLING CROSSROADS REAR 5
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6278
Practice Address - Country:US
Practice Address - Phone:410-747-0341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty