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General NPI Number Information
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NPI Number | 1093906554
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Entity Type | Organization
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Legal Business Name | HAITHAM MATAR DDS INC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 539 N GLENOAKS BLVD #102
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City | BURBANK
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State | CA
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Zip | 91502
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Country | US
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Telephone | 818-559-3444
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Fax | 818-559-3689
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Provider Business Mailing Address
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Address Line | 539 N GLENOAKS BLVD #102
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City | BURBANK
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State | CA
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Zip | 91502
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Country | US
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Telephone | 818-559-3444
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Fax | 818-559-3689
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | MR. HAITHAM MATAR
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Credential |
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Telephone | 818-559-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41650
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License Number State | CA
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