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Individual
MICA MATHISON
Active
Individual
MICA MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN015719
GA
1223G0001X
General Practice Dentistry
Primary
DS0000010581
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
02/11/2017
Last updated
10/26/2020
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