Provider Demographics
NPI:1063826139
Name:MATIN D.D.S, INC.
Entity Type:Organization
Organization Name:MATIN D.D.S, INC.
Other - Org Name:SANTA FE SMILES DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GULALAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-471-6011
Mailing Address - Street 1:365 S RANCHO SANTA FE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2338
Mailing Address - Country:US
Mailing Address - Phone:760-471-6011
Mailing Address - Fax:760-471-6010
Practice Address - Street 1:365 S RANCHO SANTA FE RD
Practice Address - Street 2:STE 201
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2338
Practice Address - Country:US
Practice Address - Phone:760-471-6011
Practice Address - Fax:760-471-6010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATIN D.D.S, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty