Provider Demographics
NPI:1891926382
Name:DANIEL W MATHEWS DMD PC
Entity Type:Organization
Organization Name:DANIEL W MATHEWS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-277-8900
Mailing Address - Street 1:4130 CARMICHAEL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3727
Mailing Address - Country:US
Mailing Address - Phone:334-277-8900
Mailing Address - Fax:334-819-8698
Practice Address - Street 1:4130 CARMICHAEL RD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3727
Practice Address - Country:US
Practice Address - Phone:334-277-8900
Practice Address - Fax:334-819-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3600122300000X
AL5690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty