Provider Demographics
NPI:1669463162
Name:TOMALA, MATTHEW PERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PERRY
Last Name:TOMALA
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 1:207 SW 156TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2561
Mailing Address - Country:US
Mailing Address - Phone:206-402-5147
Mailing Address - Fax:206-402-5172
Practice Address - Street 1:207 SW 156TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2561
Practice Address - Country:US
Practice Address - Phone:206-402-5147
Practice Address - Fax:206-402-5172
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010774122300000X
MI2901018654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist