Healthcare Provider Details

I. General information

NPI: 1831804392
Provider Name (Legal Business Name): TOKATLI MATTAR DENTAL CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16511 GOLDENWEST ST STE 108
HUNTINGTON BEACH CA
92647-4484
US

IV. Provider business mailing address

16511 GOLDENWEST ST STE 108
HUNTINGTON BEACH CA
92647-4484
US

V. Phone/Fax

Practice location:
  • Phone: 909-395-6632
  • Fax:
Mailing address:
  • Phone: 909-395-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DINA MATTAR
Title or Position: OWNER
Credential:
Phone: 909-395-6632