Provider Demographics
NPI:1801194295
Name:MATHEN, JANE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:S
Last Name:MATHEN
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 1:2315 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4178
Mailing Address - Country:US
Mailing Address - Phone:920-735-9366
Mailing Address - Fax:920-735-9616
Practice Address - Street 1:2315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4178
Practice Address - Country:US
Practice Address - Phone:920-735-9366
Practice Address - Fax:920-735-9616
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4049-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice