MEDICARE: DR. BIBBY P MATHEW DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20994	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053352781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIBBY P MATHEW DMD

Provider Business Mailing Address
First Line	:	1221 W BEN WHITE BLVD
Second Line	:	SUITE 112B
City	:	AUSTIN
State	:	TX
Zip	:	78704-7192
Country	:	US
Telephone Number	:	512-978-9700
Fax Number	:	512-279-2307

Provider Business Practice Location Address
First Line	:	1221 W BEN WHITE BLVD
Second Line	:	SUITE 112B
City	:	AUSTIN
State	:	TX
Zip	:	78704-7192
Country	:	US
Telephone Number	:	512-978-9700
Fax Number	:	512-279-2307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/12/2017

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