Provider Demographics
NPI:1013153469
Name:MATHESON AND HAN PLLC
Entity Type:Organization
Organization Name:MATHESON AND HAN PLLC
Other - Org Name:CLEARWATER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-783-5000
Mailing Address - Street 1:5000 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1964
Mailing Address - Country:US
Mailing Address - Phone:509-783-5000
Mailing Address - Fax:
Practice Address - Street 1:5000 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1964
Practice Address - Country:US
Practice Address - Phone:509-783-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000046451223G0001X
WADE000084831223G0001X
WADE000105781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215241567OtherDR THOMAS NPI
WADE00008483OtherSTATE DENTAL LICENSE-HAN
WADE60173351OtherDR THOMAS
WA0021156OtherL & I
WA1891867875OtherNPI DR HAN
WADE00004645OtherSTATE DENTAL LICENSE-MATHESON
WA5510003Medicaid
WADE60478319OtherDR ROSE
WA1104231497OtherDR ROSE NPI
WA1538238779OtherNPI DR MATHESON