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General NPI Number Information
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NPI Number | 1891365433
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Entity Type | Individual
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Provider Name | MIKA MATSUMOTO DDS
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Gender | Female
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 06/27/2021
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Provider Practice Location Address
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Address Line | 14655 BEL-RED ROAD UNIT 101
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City | BELLEVUE
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State | WA
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Zip | 98007
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Country | US
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Telephone | 425-641-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 4547 8TH AVE NE APT 509
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City | SEATTLE
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State | WA
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Zip | 98105-6707
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Country | US
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Telephone | 808-292-5396
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61168232
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License Number State | WA
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