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General NPI Number Information
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NPI Number | 1063872968
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Entity Type | Organization
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Legal Business Name | R CRAIG MATHEWS DDS INC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 530 W UNION ST SUITE A
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City | ATHENS
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State | OH
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Zip | 45701-8303
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Country | US
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Telephone | 740-592-1483
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Fax | 740-593-6602
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Provider Business Mailing Address
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Address Line | 530 W UNION ST SUITE A
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City | ATHENS
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State | OH
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Zip | 45701-8303
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Country | US
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Telephone | 740-592-1483
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Fax | 740-593-6602
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL C MATHEWS
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Credential | DDS
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Telephone | 740-592-1483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.015779
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License Number State | OH
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