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NPI Code Detail

MEDICARE: ALEXANDER MATHESON DMD

MEDICARE: ALEXANDER MATHESON DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD7176AZ

General Provider Information

NPI Number : 1740473578
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER MATHESON DMD
Provider Business Mailing Address
First Line : 6601 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1219
Country : US
Telephone Number : 602-336-0061
Fax Number : 602-336-0249
Provider Business Practice Location Address
First Line : 6601 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1219
Country : US
Telephone Number : 602-336-0061
Fax Number : 602-336-0249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2007
Last Update Date : 08/24/2007

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