1194436352 NPI number — DIPTI MATHUR DDS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194436352 NPI number — DIPTI MATHUR DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIPTI MATHUR DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194436352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1708 WALDEN MEADOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27523-4823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-605-4841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7283 NC HIGHWAY 42 STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27603-7530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-424-7203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MATHUR
Authorized Official First Name:
DIPTI
Authorized Official Middle Name:
CHANDRA
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
412-605-4841

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215343223 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com