Provider Demographics
NPI:1336526227
Name:ANIL M MATHEW DMD & ANNIE P MATHEW DMD PA
Entity Type:Organization
Organization Name:ANIL M MATHEW DMD & ANNIE P MATHEW DMD PA
Other - Org Name:BRIER CREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-598-7081
Mailing Address - Street 1:7780 BRIER CREEK PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7849
Mailing Address - Country:US
Mailing Address - Phone:919-598-7081
Mailing Address - Fax:919-598-7083
Practice Address - Street 1:7780 BRIER CREEK PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7849
Practice Address - Country:US
Practice Address - Phone:919-598-7081
Practice Address - Fax:919-598-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7742122300000X
NC7741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty