Individual
KURIAN MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16620 W 159TH ST, LOCKPORT, IL 60441-8012
(217) 540-5100
Mailing address
PO BOX 11568, OVERLAND PARK, KS 66207-4268
(913) 428-1670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019028006
IL
122300000X
Dentist
Primary
12012091A
IN
122300000X
Dentist
6441-15
WI
Other
Enumeration date
08/01/2009
Last updated
08/29/2018
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