Provider Demographics
NPI:1356851141
Name:MATHEW, GEORGE CHERUKARA (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHERUKARA
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 80TH AVE SE APT 204
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2901
Mailing Address - Country:US
Mailing Address - Phone:412-953-0969
Mailing Address - Fax:
Practice Address - Street 1:3235 NW PLAZA RD UNIT 2
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8101
Practice Address - Country:US
Practice Address - Phone:412-953-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611635351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty