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General NPI Number Information
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NPI Number | 1770034514
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Entity Type | Organization
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Legal Business Name | MATTHEW C DO DDS INC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 100 PARK AVE
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City | MONTEREY
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State | CA
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Zip | 93940-3324
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Country | US
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Telephone | 831-373-4116
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PARK AVE
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City | MONTEREY
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State | CA
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Zip | 93940-3324
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Country | US
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Telephone | 831-373-4116
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW C DO
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Credential | DDS
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Telephone | 831-373-4116
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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 | 45452
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License Number State | CA
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