Provider Demographics
NPI:1902655087
Name:JEFFREY W MATHEWS DDS PLLC
Entity type:Organization
Organization Name:JEFFREY W MATHEWS DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-944-5444
Mailing Address - Street 1:919 CONFERENCE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1924
Mailing Address - Country:US
Mailing Address - Phone:615-855-0087
Mailing Address - Fax:615-855-0078
Practice Address - Street 1:919 CONFERENCE DR STE 5
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1924
Practice Address - Country:US
Practice Address - Phone:615-855-0087
Practice Address - Fax:615-855-0078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY W MATHEWS DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-13
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1932658994OtherDR. KELLEY
TN1013577063OtherDR. KANG
TN1265705644OtherDR. MATHEWS