Provider Demographics
NPI:1740032127
Name:MATHEW, ANCEL C (DMD)
Entity type:Individual
Prefix:
First Name:ANCEL
Middle Name:C
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 ALDENHAM DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7272
Mailing Address - Country:US
Mailing Address - Phone:972-800-6878
Mailing Address - Fax:
Practice Address - Street 1:4122 ALDENHAM DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-7272
Practice Address - Country:US
Practice Address - Phone:972-800-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
TX41713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health