Provider Demographics
NPI:1992041743
Name:MATHEWS & MATHEWS DENTAL
Entity Type:Organization
Organization Name:MATHEWS & MATHEWS DENTAL
Other - Org Name:MATHEWS & MATHEWS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
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:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36001223G0001X
AL56901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty