Healthcare Provider Details

I. General information

NPI: 1477585271
Provider Name (Legal Business Name): EDWARD M. MATSUISHI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 STOCKTON AVE STE 3
EL CERRITO CA
94530-2961
US

IV. Provider business mailing address

7001 STOCKTON AVENUE #3
EL CERRITO CA
94530
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-4633
  • Fax: 510-524-4678
Mailing address:
  • Phone: 510-524-4633
  • Fax: 510-524-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number19514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: