Provider Demographics
NPI:1790992246
Name:MATIN, KATE (DDS)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MATIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WELCH RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1602
Mailing Address - Country:US
Mailing Address - Phone:650-329-8160
Mailing Address - Fax:
Practice Address - Street 1:777 WELCH RD STE C
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1602
Practice Address - Country:US
Practice Address - Phone:650-329-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice