Provider Demographics
NPI:1861830853
Name:MATHEWS, SHELLEY FAY (RDH ECP II)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:FAY
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RDH ECP II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N 12TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5105
Mailing Address - Country:US
Mailing Address - Phone:913-342-2552
Mailing Address - Fax:913-428-8999
Practice Address - Street 1:21 N 12TH ST STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5105
Practice Address - Country:US
Practice Address - Phone:913-342-2552
Practice Address - Fax:913-428-8999
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10670124Q00000X
MO2011037744124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist