Provider Demographics
NPI:1750447553
Name:MATSON, JEFFREY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:MATSON
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 1:1314 8TH ST NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4587
Mailing Address - Country:US
Mailing Address - Phone:253-833-6120
Mailing Address - Fax:253-833-1457
Practice Address - Street 1:1314 8TH ST NE
Practice Address - Street 2:SUITE 104
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4587
Practice Address - Country:US
Practice Address - Phone:253-833-6120
Practice Address - Fax:253-833-1457
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5012539OtherDSHS