Provider Demographics
NPI:1487727756
Name:MATHEW, SHYLON T (DDS)
Entity type:Individual
Prefix:
First Name:SHYLON
Middle Name:T
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HIGH MANOR DR
Mailing Address - Street 2:APT. 1
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9109
Mailing Address - Country:US
Mailing Address - Phone:973-615-5113
Mailing Address - Fax:
Practice Address - Street 1:1510 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2405
Practice Address - Country:US
Practice Address - Phone:585-865-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry