Provider Demographics
NPI:1457361610
Name:MATHEW, ANIL MATHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:MATHEN
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 1:12309 RICHMOND RUN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6413
Mailing Address - Country:US
Mailing Address - Phone:919-562-8679
Mailing Address - Fax:
Practice Address - Street 1:7780 BRIER CREEK PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7316
Practice Address - Country:US
Practice Address - Phone:919-786-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77421223G0001X
NY0447861223G0001X
NJ22DI018629001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice