Provider Demographics
NPI:1134506009
Name:MATSUMURA, SATOKO (DDS, PHD, MDS)
Entity Type:Individual
Prefix:DR
First Name:SATOKO
Middle Name:
Last Name:MATSUMURA
Suffix:
Gender:F
Credentials:DDS, PHD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST PH7 STEM-134
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3006
Mailing Address - Country:US
Mailing Address - Phone:212-304-7056
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST PH7 STEM-134
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3006
Practice Address - Country:US
Practice Address - Phone:212-304-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001021223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology