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General NPI Number Information
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NPI Number | 1649527730
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Entity Type | Individual
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Provider Name | JACQUELYN P MATHEWS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 28451 N VISTANCIA BLVD SUITE 101
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City | PEORIA
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State | AZ
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Zip | 85383-2090
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Country | US
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Telephone | 623-218-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 E BRENTRUP DR
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City | TEMPE
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State | AZ
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Zip | 85283-4782
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Country | US
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Telephone | 480-861-5338
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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 | 6966-15
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License Number State | WI
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