Provider Demographics
NPI:1053352781
Name:MATHEW, BIBBY P (DMD)
Entity type:Individual
Prefix:DR
First Name:BIBBY
Middle Name:P
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 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7192
Mailing Address - Country:US
Mailing Address - Phone:512-978-9700
Mailing Address - Fax:512-279-2307
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE 112B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:512-978-9700
Practice Address - Fax:512-279-2307
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431823399Medicaid