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General NPI Number Information
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NPI Number | 1356851141
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Entity Type | Individual
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Provider Name | GEORGE CHERUKARA MATHEW DMD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 3235 NW PLAZA RD UNIT 2
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City | SILVERDALE
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State | WA
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Zip | 98383-8101
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Country | US
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Telephone | 412-953-0969
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Fax |
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Provider Business Mailing Address
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Address Line | 3239 80TH AVE SE APT 204
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2901
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Country | US
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Telephone | 412-953-0969
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE61163535
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License Number State | WA
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