Provider Demographics
NPI:1104495936
Name:MATHUR, AJAY (DDS, MDS, BDS)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:DDS, MDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5131
Mailing Address - Country:US
Mailing Address - Phone:650-235-1461
Mailing Address - Fax:
Practice Address - Street 1:4100 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-5131
Practice Address - Country:US
Practice Address - Phone:650-235-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist