Provider Demographics
NPI:1275947343
Name:G. MATIN D.D.S INC.
Entity Type:Organization
Organization Name:G. MATIN D.D.S INC.
Other - Org Name:MCCALL DENTAL PRACTICE
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:951-723-1188
Mailing Address - Street 1:28115 BRADLEY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2239
Mailing Address - Country:US
Mailing Address - Phone:951-723-1188
Mailing Address - Fax:951-723-1198
Practice Address - Street 1:28115 BRADLEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2239
Practice Address - Country:US
Practice Address - Phone:951-723-1188
Practice Address - Fax:951-723-1198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G. 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