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General NPI Number Information
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NPI Number | 1083371876
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Entity Type | Individual
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Provider Name | JAYCE MATHEW DDS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 30 S CLAYTON ST APT 4306
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5782
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Country | US
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Telephone | 516-884-5418
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S CLAYTON ST APT 4306
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5782
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Country | US
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Telephone | 516-884-5418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN122558
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License Number State | GA
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