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General NPI Number Information
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NPI Number | 1346467511
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Entity Type | Organization
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Legal Business Name | BARRY R. MATHESON, DDS, MSD PC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 817 GATE CITY HIGHWAY
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City | BRISTOL
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State | VA
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Zip | 24201
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Country | US
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Telephone | 276-669-1231
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Fax | 276-466-6872
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Provider Business Mailing Address
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Address Line | 817 GATE CITY HIGHWAY
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City | BRISTOL
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State | VA
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Zip | 24201
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Country | US
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Telephone | 276-669-1231
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Fax | 276-466-6872
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY ROBERT MATHESON
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Credential | D.D.S., M.S.D.
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Telephone | 276-669-1231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS0000005057
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 14875
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401006603
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License Number State | VA
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