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General NPI Number Information
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NPI Number | 1659180578
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Entity Type | Organization
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Legal Business Name | MATTY DENTAL GROUP
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 480 N MAGNOLIA AVE STE 103
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City | EL CAJON
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State | CA
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Zip | 92020-3611
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Country | US
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Telephone | 619-444-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 9149 SINGLE OAK DR
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City | LAKESIDE
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State | CA
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Zip | 92040-4521
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Country | US
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Telephone | 714-307-1486
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. DANNY SALEM MATTY
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Credential | DDS
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Telephone | 714-307-1486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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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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