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General NPI Number Information
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NPI Number | 1407489826
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Entity Type | Organization
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Legal Business Name | DANA MATLOCK, DDS, LLC
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 123 SE DOUGLAS ST
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City | NEWPORT
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State | OR
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Zip | 97365-4426
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Country | US
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Telephone | 541-264-2800
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Fax | 541-265-8617
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Provider Business Mailing Address
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Address Line | 123 SE DOUGLAS ST
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City | NEWPORT
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State | OR
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Zip | 97365-4426
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Country | US
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Telephone | 541-264-2800
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Fax | 541-265-8617
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DANA MATLOCK
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Credential | DDS
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Telephone | 541-264-2800
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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 |
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License Number State |
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