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General NPI Number Information
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NPI Number | 1447346481
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Entity Type | Organization
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Legal Business Name | MASAKI DURANGO DENTAL GROUP, PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 3140 S DURANGO DR STE. 100
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City | LAS VEGAS
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State | NV
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Zip | 89117-9189
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Country | US
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Telephone | 702-362-1856
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Fax | 702-804-0465
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW G K MASAKI
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Credential | DDS
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Telephone | 702-362-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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