Provider Demographics
NPI:1689083248
Name:MATHEWS, RYAN (RDHAP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16009 NORDHOFF ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3041
Mailing Address - Country:US
Mailing Address - Phone:818-934-3550
Mailing Address - Fax:
Practice Address - Street 1:16009 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3041
Practice Address - Country:US
Practice Address - Phone:818-934-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist