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General NPI Number Information
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NPI Number | 1164910659
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Entity Type | Individual
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Provider Name | DANIEL MATZ DMD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 4070 W 72ND AVE
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City | WESTMINSTER
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State | CO
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Zip | 80030-5210
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Country | US
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Telephone | 303-429-7072
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Fax |
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Provider Business Mailing Address
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Address Line | 8014 SAGEBRUSH CT
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City | BOULDER
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State | CO
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Zip | 80301-5009
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Country | US
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Telephone | 570-294-3145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 00203488
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License Number State | CO
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