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General NPI Number Information
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NPI Number | 1376799445
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Entity Type | Individual
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Provider Name | XAVIER MATA D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 8608 S 30TH WAY
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City | PHOENIX
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State | AZ
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Zip | 85042-8249
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Country | US
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Telephone | 480-268-1569
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Fax |
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Provider Business Mailing Address
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Address Line | 8608 S 30TH WAY
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City | PHOENIX
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State | AZ
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Zip | 85042-8249
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Country | US
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Telephone | 480-268-1569
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 60014
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 14245
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8075
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License Number State | AZ
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