Provider Demographics
NPI:1538508882
Name:MATHER, DAVID ATHERTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ATHERTON
Last Name:MATHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 N WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4971
Mailing Address - Country:US
Mailing Address - Phone:423-247-5175
Mailing Address - Fax:423-247-0019
Practice Address - Street 1:1203 N WILCOX DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4971
Practice Address - Country:US
Practice Address - Phone:423-247-5175
Practice Address - Fax:423-247-0019
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice