Provider Demographics
NPI:1750487732
Name:MATHEW, VINOD VERGHESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:VERGHESE
Last Name:MATHEW
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 1:6801 PLEASANT PINES DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1925
Mailing Address - Country:US
Mailing Address - Phone:919-510-5006
Mailing Address - Fax:919-510-5065
Practice Address - Street 1:6801 PLEASANT PINES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1925
Practice Address - Country:US
Practice Address - Phone:919-510-5006
Practice Address - Fax:919-510-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice