MEDICARE: DR. MADJID MATIN DMD

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	1223P0300X	Periodontics	11177	MD

General Provider Information

NPI Number	:	1427051424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADJID MATIN DMD

Provider Business Mailing Address
First Line	:	5530 WISCONSIN AVE
Second Line	:	STE 1110
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4330
Country	:	US
Telephone Number	:	301-656-6424
Fax Number	:	301-656-6425

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE
Second Line	:	STE 1110
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4330
Country	:	US
Telephone Number	:	301-656-6424
Fax Number	:	301-656-6425

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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