Provider Demographics
NPI:1063872968
Name:R CRAIG MATHEWS DDS INC
Entity type:Organization
Organization Name:R CRAIG MATHEWS DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-592-1483
Mailing Address - Street 1:530 W UNION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8303
Mailing Address - Country:US
Mailing Address - Phone:740-592-1483
Mailing Address - Fax:740-593-6602
Practice Address - Street 1:530 W UNION ST
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8303
Practice Address - Country:US
Practice Address - Phone:740-592-1483
Practice Address - Fax:740-593-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0157791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty