Healthcare Provider Details

I. General information

NPI: 1972048494
Provider Name (Legal Business Name): MICHAEL S MATHEWS DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 THONOTOSASSA RD STE A
PLANT CITY FL
33563-2972
US

IV. Provider business mailing address

2005 THONOTOSASSA RD STE A
PLANT CITY FL
33563-2972
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-3794
  • Fax: 813-754-1677
Mailing address:
  • Phone: 813-754-3794
  • Fax: 813-754-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14621
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL STEVEN MATHEWS
Title or Position: PRESIDENT
Credential: DMD
Phone: 813-754-3794