Provider Demographics
NPI:1447384268
Name:MATTINSON, CRAIG J (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:MATTINSON
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 1:1355 N MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5982
Mailing Address - Country:US
Mailing Address - Phone:801-294-3345
Mailing Address - Fax:801-594-5539
Practice Address - Street 1:1355 N MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5982
Practice Address - Country:US
Practice Address - Phone:801-294-3345
Practice Address - Fax:801-594-5539
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344310-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice