Provider Demographics
NPI:1194436352
Name:DIPTI MATHUR DDS PLLC
Entity type:Organization
Organization Name:DIPTI MATHUR DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPTI
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-605-4841
Mailing Address - Street 1:1708 WALDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-4823
Mailing Address - Country:US
Mailing Address - Phone:412-605-4841
Mailing Address - Fax:
Practice Address - Street 1:7283 NC HIGHWAY 42 STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-7530
Practice Address - Country:US
Practice Address - Phone:919-424-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215343223Medicaid