Provider Demographics
NPI:1003095951
Name:MATIN, BITA LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BITA
Middle Name:LOUISE
Last Name:MATIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 BALHAN DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521
Mailing Address - Country:US
Mailing Address - Phone:925-682-2002
Mailing Address - Fax:925-682-6532
Practice Address - Street 1:1494 BALHAN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521
Practice Address - Country:US
Practice Address - Phone:925-682-2002
Practice Address - Fax:925-682-6532
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist