Provider Demographics
NPI:1922309418
Name:MATHEW, ANITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:MATHEW
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 1:1021 BARBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4541
Mailing Address - Country:US
Mailing Address - Phone:706-546-6451
Mailing Address - Fax:706-549-1902
Practice Address - Street 1:1021 BARBER CREEK DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4541
Practice Address - Country:US
Practice Address - Phone:706-546-6451
Practice Address - Fax:706-549-1902
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014457122300000X
OH30-023334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist