Provider Demographics
NPI:1477843266
Name:JEFFREY J MATSON DDS INC
Entity Type:Organization
Organization Name:JEFFREY J MATSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-833-6120
Mailing Address - Street 1:1314 8TH ST NE STE 104
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4587
Mailing Address - Country:US
Mailing Address - Phone:253-833-6120
Mailing Address - Fax:253-833-1457
Practice Address - Street 1:1314 8TH ST NE STE 104
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4587
Practice Address - Country:US
Practice Address - Phone:253-833-6120
Practice Address - Fax:253-833-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6377332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6499960001Medicare NSC