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General NPI Number Information
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NPI Number | 1528230935
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Entity Type | Organization
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Legal Business Name | VIJAY A. MATHURA DDS PA
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 4 W ROLLING CROSSROADS REAR 5
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City | CATONSVILLE
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State | MD
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Zip | 21228-6278
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Country | US
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Telephone | 410-747-0341
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Fax |
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Provider Business Mailing Address
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Address Line | 4 W ROLLING CROSSROADS REAR 5
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City | CATONSVILLE
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State | MD
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Zip | 21228-6278
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Country | US
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Telephone | 410-747-0341
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIJAY MATHURA
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Credential |
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Telephone | 410-747-0341
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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 | 11868
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License Number State | MD
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