1356851141 NPI number — DR. GEORGE CHERUKARA MATHEW DMD

Table of content: DR. GEORGE CHERUKARA MATHEW DMD (NPI 1356851141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356851141 NPI number — DR. GEORGE CHERUKARA MATHEW DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEW
Provider First Name:
GEORGE
Provider Middle Name:
CHERUKARA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356851141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3239 80TH AVE SE APT 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-953-0969
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3235 NW PLAZA RD UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-953-0969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE61163535 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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