Healthcare Provider Details

I. General information

NPI: 1265567184
Provider Name (Legal Business Name): DAVID P MATHEWS DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 S 19TH ST STE 101
TACOMA WA
98405
US

IV. Provider business mailing address

4050 S 19TH ST STE 101
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-6622
  • Fax: 253-756-5875
Mailing address:
  • Phone: 253-752-6622
  • Fax: 253-756-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4439
License Number StateWA

VIII. Authorized Official

Name: DAVID P MATHEWS
Title or Position: DENTIST PRESIDENT
Credential: DDS
Phone: 253-752-6622