Provider Demographics
NPI:1932247558
Name:MATHEWS, BOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 RIDGELYS CHOICE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3026
Mailing Address - Country:US
Mailing Address - Phone:410-248-0025
Mailing Address - Fax:
Practice Address - Street 1:8615 RIDGELYS CHOICE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3026
Practice Address - Country:US
Practice Address - Phone:410-248-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice