Healthcare Provider Details

I. General information

NPI: 1659180578
Provider Name (Legal Business Name): MATTY DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 N MAGNOLIA AVE STE 103
EL CAJON CA
92020-3611
US

IV. Provider business mailing address

9149 SINGLE OAK DR
LAKESIDE CA
92040-4521
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-6355
  • Fax:
Mailing address:
  • Phone: 714-307-1486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DANNY SALEM MATTY
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 714-307-1486