Provider Demographics
NPI:1558884197
Name:MATHEWS, PRIYA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:ANN
Last Name:MATHEWS
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 1:4875 CARLSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4647
Mailing Address - Country:US
Mailing Address - Phone:248-881-0785
Mailing Address - Fax:
Practice Address - Street 1:4929 S BALDWIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2118
Practice Address - Country:US
Practice Address - Phone:248-462-7209
Practice Address - Fax:248-720-9881
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist