MEDICARE: DR. TREASA MATHEW D.M.D

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	DN1855964	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN1855964	OTHER	MA	THE COMMONWEALTH OF MASSACHUSETTS HEALTH PROFESSIONS LICENSURE

General Provider Information

NPI Number	:	1205197720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREASA MATHEW D.M.D

Provider Business Mailing Address
First Line	:	106 COLONY PLACE RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7233
Country	:	US
Telephone Number	:	508-830-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 NEWPORT AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-2610
Country	:	US
Telephone Number	:	617-773-9902
Fax Number	:

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	02/22/2016

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