Provider Demographics
NPI:1295870111
Name:MATHEWS, JENNY (DDS MS PHD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:DDS MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2439
Mailing Address - Country:US
Mailing Address - Phone:203-227-8990
Mailing Address - Fax:203-227-3975
Practice Address - Street 1:131 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2439
Practice Address - Country:US
Practice Address - Phone:203-227-8990
Practice Address - Fax:203-227-3975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92221223P0300X
NY049666-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics