MEDICARE: DR. THOMAS KENNETH MATSUI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	105042	CO

General Provider Information

NPI Number	:	1215152848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KENNETH MATSUI DDS

Provider Business Mailing Address
First Line	:	1526 COLE BLVD
Second Line	:	#120
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3410
Country	:	US
Telephone Number	:	303-234-0505
Fax Number	:	303-234-0226

Provider Business Practice Location Address
First Line	:	1526 COLE BLVD
Second Line	:	#120
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3410
Country	:	US
Telephone Number	:	303-234-0505
Fax Number	:	303-234-0226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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