Provider Demographics
NPI:1952663668
Name:MATSUDA, MICHAEL LOREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOREN
Last Name:MATSUDA
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 1:363 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4281
Mailing Address - Country:US
Mailing Address - Phone:503-640-1313
Mailing Address - Fax:503-640-0126
Practice Address - Street 1:363 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4281
Practice Address - Country:US
Practice Address - Phone:503-640-1313
Practice Address - Fax:503-640-0126
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics