Provider Demographics
NPI:1558411488
Name:JAMES C. MATTSON, DMD, PC
Entity Type:Organization
Organization Name:JAMES C. MATTSON, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-649-4211
Mailing Address - Street 1:18455 SW ALEXANDER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3967
Mailing Address - Country:US
Mailing Address - Phone:503-649-4211
Mailing Address - Fax:503-649-6123
Practice Address - Street 1:18455 SW ALEXANDER ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3967
Practice Address - Country:US
Practice Address - Phone:503-649-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD48451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty