Provider Demographics
NPI:1972048494
Name:MICHAEL S MATHEWS DMD PA
Entity Type:Organization
Organization Name:MICHAEL S MATHEWS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-754-3794
Mailing Address - Street 1:2005 THONOTOSASSA RD
Mailing Address - Street 2:STE A
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2972
Mailing Address - Country:US
Mailing Address - Phone:813-754-3794
Mailing Address - Fax:813-754-1677
Practice Address - Street 1:2005 THONOTOSASSA RD
Practice Address - Street 2:STE A
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2972
Practice Address - Country:US
Practice Address - Phone:813-754-3794
Practice Address - Fax:813-754-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty