Provider Demographics
NPI:1558973826
Name:MATTA DENTAL CARE PLC
Entity Type:Organization
Organization Name:MATTA DENTAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:515-262-1923
Mailing Address - Street 1:14031 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8317
Mailing Address - Country:US
Mailing Address - Phone:205-617-7417
Mailing Address - Fax:
Practice Address - Street 1:2476 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-3658
Practice Address - Country:US
Practice Address - Phone:515-262-1923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty