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NPI Code Detail

MEDICARE: ALEX MATSUMOTO DMD

MEDICARE: ALEX MATSUMOTO DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDT2716HI

General Provider Information

NPI Number : 1003322421
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALEX MATSUMOTO DMD
Provider Business Mailing Address
First Line : 2916 PAHOEHOE PL
Second Line :
City : HONOLULU
State : HI
Zip : 96817-1413
Country : US
Telephone Number : 808-284-1493
Fax Number :
Provider Business Practice Location Address
First Line : 91-902 FORT WEAVER RD STE 208
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-2261
Country : US
Telephone Number : 808-689-7964
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. ALEX AKIO MATSUMOTO
Credential : DMD
Telephone Number : 808-284-1493
Provider Enumeration Date : 12/21/2017
Last Update Date : 12/21/2017

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Directions to “ALEX MATSUMOTO DMD ” Practice Location

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