Healthcare Provider Details

I. General information

NPI: 1295731776
Provider Name (Legal Business Name): LESLIE T MATSUMURA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MURRIETA BLVD STE 201
LIVERMORE CA
94550-4143
US

IV. Provider business mailing address

1171 MURRIETA BLVD STE 201
LIVERMORE CA
94550-4143
US

V. Phone/Fax

Practice location:
  • Phone: 925-960-0990
  • Fax: 925-960-9977
Mailing address:
  • Phone: 925-960-0990
  • Fax: 925-960-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: