Provider Demographics
NPI:1851413025
Name:MATHESON, DUNCAN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUNCAN
Middle Name:
Last Name:MATHESON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DUNCAN
Other - Middle Name:
Other - Last Name:MATHESON
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5404 INDIAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3334
Mailing Address - Country:US
Mailing Address - Phone:228-255-2543
Mailing Address - Fax:
Practice Address - Street 1:5404 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3334
Practice Address - Country:US
Practice Address - Phone:228-255-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1759-771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice