Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4439 | WA |
NPI | 1053581546 |
---|---|
Provider Name | David P Mathews |
First Address | Tacoma, WA 98405 |
Second Address | Tacoma, WA 98405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2008 |
Last Update Date | 11/03/2008 |