MEDICARE: MARTY J. MATZ, D.D.S.

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	122300000X	Dentist	7165	NE

General Provider Information

NPI Number	:	1902219520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTY J. MATZ, D.D.S.

Provider Business Mailing Address
First Line	:	15751 W DODGE RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2536
Country	:	US
Telephone Number	:	402-397-8050
Fax Number	:	402-397-9566

Provider Business Practice Location Address
First Line	:	15751 W DODGE RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2536
Country	:	US
Telephone Number	:	402-397-8050
Fax Number	:	402-397-9566

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MARTY MATZ
Credential	:	D.D.S.
Telephone Number	:	402-397-8050

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	12/14/2015

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