Provider Demographics
NPI:1629373618
Name:MATHEW, ANGELA MABEL (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MABEL
Last Name:MATHEW
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 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:500 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 438A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5845
Practice Address - Country:US
Practice Address - Phone:512-326-3473
Practice Address - Fax:512-326-5439
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice