MEDICARE: SARAH ELIZABETH MATHEW 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
1	1223G0001X	General Practice Dentistry	DN23903	FL

General Provider Information

NPI Number	:	1982198305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH MATHEW DMD

Provider Business Mailing Address
First Line	:	777 N ORANGE AVE APT 539
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-1185
Country	:	US
Telephone Number	:	805-804-7632
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 S ORLANDO AVE STE 10
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-3656
Country	:	US
Telephone Number	:	407-691-3447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	09/22/2020

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