Provider Demographics
NPI:1629111976
Name:MATHEWS, RANDALL CRAIG (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:CRAIG
Last Name:MATHEWS
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 1:530 W UNION ST
Mailing Address - Street 2:STE A
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8303
Mailing Address - Country:US
Mailing Address - Phone:740-592-1483
Mailing Address - Fax:740-593-6602
Practice Address - Street 1:530 W UNION ST
Practice Address - Street 2:STE A
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8303
Practice Address - Country:US
Practice Address - Phone:740-592-1483
Practice Address - Fax:740-593-6602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice