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General NPI Number Information
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NPI Number | 1700165917
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Entity Type | Individual
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Provider Name | MATTHEW DURSCHLAG D.D.S., MS
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Gender | Male
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 239 LAUREL ST STE 201
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City | SAN DIEGO
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State | CA
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Zip | 92101-1473
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Country | US
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Telephone | 619-291-5266
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Fax |
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Provider Business Mailing Address
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Address Line | 11921 CARMEL CREEK RD APT 109
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City | SAN DIEGO
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State | CA
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Zip | 92130-2566
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Country | US
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Telephone | 858-248-7005
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 33658
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60558
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License Number State | CA
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