Organization
MATHI THEVA DMD PC
Active
Other names
Unident Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MATHI THEVA (PRESIDENT)
(508) 583-3840
Entity
Organization
Contact information
Practice address
200 WEST GATE DR, SUITE 135, BROCKTON, MA 02301
(508) 583-3840
Mailing address
200 WEST GATE DR, SUITE 135, BROCKTON, MA 02301
(508) 583-3840
(508) 559-6577
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9769862
—
MA
Enumeration date
07/01/2006
Last updated
08/22/2020
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