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General NPI Number Information
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NPI Number | 1902305386
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Entity Type | Individual
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Provider Name | SHERRYL MARY MATHEW DDS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 1800 FORT HARRISON RD
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City | TERRE HAUTE
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State | IN
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Zip | 47804-1413
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Country | US
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Telephone | 812-645-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 629 ANTIOCH CIR W
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9456
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Country | US
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Telephone | 479-925-5731
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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 | 12012884A
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License Number State | IN
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