Provider Demographics
NPI:1770663320
Name:MATHEWS, SEAN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:L
Last Name:MATHEWS
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 1:5025 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1911
Mailing Address - Country:US
Mailing Address - Phone:509-783-0822
Mailing Address - Fax:509-736-3504
Practice Address - Street 1:5025 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1911
Practice Address - Country:US
Practice Address - Phone:509-783-0822
Practice Address - Fax:509-736-3504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice