Healthcare Provider Details

I. General information

NPI: 1063506624
Provider Name (Legal Business Name): SHIRLEY E MATHEW DDS, FAGD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 HEBRON PKWY SUITE 902
LEWISVILLE TX
75057-5003
US

IV. Provider business mailing address

860 HEBRON PKWY SUITE 902
LEWISVILLE TX
75057-5003
US

V. Phone/Fax

Practice location:
  • Phone: 972-459-1100
  • Fax: 469-675-6495
Mailing address:
  • Phone: 972-459-1100
  • Fax: 469-675-6495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: