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General NPI Number Information
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NPI Number | 1275947343
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Entity Type | Organization
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Legal Business Name | G. 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 | 28115 BRADLEY RD SUITE 3
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City | SUN CITY
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State | CA
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Zip | 92586-2239
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Country | US
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Telephone | 951-723-1188
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Fax | 951-723-1198
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Provider Business Mailing Address
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Address Line | 28115 BRADLEY RD SUITE 3
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City | SUN CITY
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State | CA
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Zip | 92586-2239
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Country | US
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Telephone | 951-723-1188
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Fax | 951-723-1198
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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 | 951-723-1188
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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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