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General NPI Number Information
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NPI Number | 1720311905
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Entity Type | Organization
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Legal Business Name | MATTHEW TOMALA DDS MSD PLLC
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Dates
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Enumeration Date | 09/07/2009
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 207 SW 156TH ST STE 2
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City | BURIEN
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State | WA
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Zip | 98166-2561
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Country | US
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Telephone | 206-402-5147
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Fax | 206-402-5172
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Provider Business Mailing Address
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Address Line | 207 SW 156TH ST STE 2
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City | BURIEN
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State | WA
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Zip | 98166-2561
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Country | US
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Telephone | 206-402-5147
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Fax | 206-402-5172
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. MATTHEW PERRY TOMALA
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Credential | DDS, MSD
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Telephone | 206-402-5147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DE00010774
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License Number State | WA
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