Individual
MATHI THEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 WEST GATE DR, SUITE 135 UNIDENT DENTAL CENTER, BROCKTON, MA 02301
(508) 583-3840
(508) 559-6577
Mailing address
99 CANAVAN DRIVE, BRAINTREE, MA 02184
(781) 849-3422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17809
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0273449
—
MA
Enumeration date
07/01/2006
Last updated
07/08/2007
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