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General NPI Number Information
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NPI Number | 1396128104
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Entity Type | Individual
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Provider Name | TRESA TEENU MATHEW D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 75 GILCREAST RD UNIT 108
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City | LONDONDERRY
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State | NH
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Zip | 03053-3565
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Country | US
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Telephone | 603-945-9966
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MEETING ROCK DR
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City | ATKINSON
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State | NH
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Zip | 03811-2143
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Country | US
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Telephone | 757-739-3968
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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 | DN1856908
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License Number State | MA
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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 | 04341
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License Number State | NH
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