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General NPI Number Information
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NPI Number | 1114324456
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Entity Type | Organization
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Legal Business Name | MATSUMORI DENTAL, PLLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 870 E 9400 S STE 110
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City | SANDY
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State | UT
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Zip | 84094-3689
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Country | US
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Telephone | 801-571-8391
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Fax | 801-571-8285
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Provider Business Mailing Address
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Address Line | 870 E 9400 S STE 110
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City | SANDY
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State | UT
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Zip | 84094-3689
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Country | US
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Telephone | 801-571-8391
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Fax | 801-571-8285
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DEVIN T MATSUMORI
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Credential |
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Telephone | 801-571-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7987460-9921
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License Number State | UT
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