Provider Demographics
NPI:1386067569
Name:MATHEW, JESSIE A (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:A
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W HILLCREST BLVD
Mailing Address - Street 2:SUITE #214
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3106
Mailing Address - Country:US
Mailing Address - Phone:847-882-3683
Mailing Address - Fax:847-882-6982
Practice Address - Street 1:80 W HILLCREST BLVD
Practice Address - Street 2:SUITE #214
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3106
Practice Address - Country:US
Practice Address - Phone:847-882-3683
Practice Address - Fax:847-882-6982
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-24603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist