Healthcare Provider Details

I. General information

NPI: 1033275391
Provider Name (Legal Business Name): I ROBERT MATLOFF DDS MS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 N 44TH ST SUITE 10
PHOENIX AZ
85018-2730
US

IV. Provider business mailing address

4910 N 44TH ST SUITE 10
PHOENIX AZ
85018-2730
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-3636
  • Fax: 602-840-7403
Mailing address:
  • Phone: 602-840-3636
  • Fax: 602-840-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD2386
License Number StateAZ

VIII. Authorized Official

Name: DR. IRA ROBERT MATLOFF
Title or Position: PRESIDENT
Credential: DDS
Phone: 602-840-3636