Provider Demographics
NPI:1578824835
Name:PLANET ORAL HEALTHCARE
Entity Type:Organization
Organization Name:PLANET ORAL HEALTHCARE
Other - Org Name:PLANET DENATL AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STAAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-648-6198
Mailing Address - Street 1:1400 GUADALUPE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 GUADALUPE ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5343
Practice Address - Country:US
Practice Address - Phone:909-648-6198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty