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General NPI Number Information
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NPI Number | 1255496840
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Entity Type | Individual
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Provider Name | GREGORY P. MATHIEU DDS
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 14425 W MCDOWELL RD SUITE F102
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City | GOODYEAR
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State | AZ
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Zip | 85395-2516
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Country | US
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Telephone | 623-536-0079
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Fax | 623-535-5176
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Provider Business Mailing Address
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Address Line | 14425 W MCDOWELL RD SUITE F102
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City | GOODYEAR
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State | AZ
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Zip | 85395-2516
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Country | US
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Telephone | 623-536-0079
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Fax | 623-535-5176
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7914
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License Number State | AZ
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