Provider Demographics
NPI:1598012163
Name:MASAKI, MATTHEW GEORGE KAIMI (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE KAIMI
Last Name:MASAKI
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 1:1077 VIA PRATO LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0600
Mailing Address - Country:US
Mailing Address - Phone:949-422-5217
Mailing Address - Fax:
Practice Address - Street 1:3140 S DURANGO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9189
Practice Address - Country:US
Practice Address - Phone:702-362-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV62951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice