MEDICARE: DANIEL A MATATIAHO DDS INC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1033978523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL A MATATIAHO DDS INC

Provider Business Mailing Address
First Line	:	8205 SANTA MONICA BLVD STE 12
Second Line	:
City	:	W HOLLYWOOD
State	:	CA
Zip	:	90046-5963
Country	:	US
Telephone Number	:	323-654-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 SANTA MONICA BLVD STE 12
Second Line	:
City	:	W HOLLYWOOD
State	:	CA
Zip	:	90046-5963
Country	:	US
Telephone Number	:	323-654-1100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DANIEL AARON MATATIAHO
Credential	:
Telephone Number	:	323-654-1100

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	02/05/2025

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