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General NPI Number Information
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NPI Number | 1063826139
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Entity Type | Organization
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Legal Business Name | MATIN D.D.S, INC.
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 365 S RANCHO SANTA FE RD STE 201
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City | SAN MARCOS
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State | CA
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Zip | 92078-2338
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Country | US
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Telephone | 760-471-6011
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Fax | 760-471-6010
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Provider Business Mailing Address
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Address Line | 365 S RANCHO SANTA FE RD STE 201
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City | SAN MARCOS
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State | CA
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Zip | 92078-2338
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Country | US
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Telephone | 760-471-6011
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Fax | 760-471-6010
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Authorized Official
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Title or Position | DENTIST
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Name | GULALAI MATIN
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Credential | DDS
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Telephone | 760-471-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 43199
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License Number State | CA
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