Provider Demographics
NPI:1992889570
Name:MATAYOSHI, ALICIA BEATRIZ (DMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BEATRIZ
Last Name:MATAYOSHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 BAYMEADOWS RD E STE 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9667
Mailing Address - Country:US
Mailing Address - Phone:904-854-2300
Mailing Address - Fax:
Practice Address - Street 1:7807 BAYMEADOWS RD E STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9667
Practice Address - Country:US
Practice Address - Phone:904-854-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice