Provider Demographics
NPI:1235278441
Name:ROBERT MATIASEVICH JR DDS INC
Entity Type:Organization
Organization Name:ROBERT MATIASEVICH JR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATIASEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-476-7272
Mailing Address - Street 1:1775 DOMINICAN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065
Mailing Address - Country:US
Mailing Address - Phone:831-476-7272
Mailing Address - Fax:831-476-1446
Practice Address - Street 1:1775 DOMINICAN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-476-7272
Practice Address - Fax:831-476-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty