Individual
MR. JOHN MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1013 W JACKSON ST, TUPELO, MS 38804-1907
(662) 823-7900
(662) 823-7920
Mailing address
1013 W JACKSON ST, TUPELO, MS 38804-1907
(662) 823-7900
(662) 823-7920
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4139-20
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4139-20
LICENSE NUMBER
MS
Enumeration date
07/22/2020
Last updated
06/08/2023
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