Provider Demographics
NPI:1053822353
Name:MATATIAHO, DANIEL AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AARON
Last Name:MATATIAHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 FOUNTAIN AVE UNIT 415
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2540
Mailing Address - Country:US
Mailing Address - Phone:323-402-4065
Mailing Address - Fax:
Practice Address - Street 1:8205 SANTA MONICA BLVD STE 12
Practice Address - Street 2:
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5963
Practice Address - Country:US
Practice Address - Phone:323-654-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1020291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty