Provider Demographics
NPI:1053581546
Name:MATHEWS, DAVID P (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
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 1:4050 S 19TH ST
Mailing Address - Street 2:#101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-752-6622
Mailing Address - Fax:253-756-5875
Practice Address - Street 1:4050 S 19TH ST
Practice Address - Street 2:#101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-752-6622
Practice Address - Fax:253-756-5875
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA44391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics