Provider Demographics
NPI:1992117725
Name:MATHEWS FAMILY DENTAL CENTER PC
Entity type:Organization
Organization Name:MATHEWS FAMILY DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-646-1360
Mailing Address - Street 1:99 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5250
Mailing Address - Country:US
Mailing Address - Phone:860-646-1360
Mailing Address - Fax:860-646-2850
Practice Address - Street 1:99 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5250
Practice Address - Country:US
Practice Address - Phone:860-646-1360
Practice Address - Fax:860-646-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty