Provider Demographics
NPI:1013924216
Name:MATZ, DOUGLAS KUOHA (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KUOHA
Last Name:MATZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 S.E. DIVISION
Mailing Address - Street 2:SUIT 309
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1354
Mailing Address - Country:US
Mailing Address - Phone:503-253-9418
Mailing Address - Fax:503-253-7286
Practice Address - Street 1:10011 S.E. DIVISION
Practice Address - Street 2:SUIT 309
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1354
Practice Address - Country:US
Practice Address - Phone:503-253-9418
Practice Address - Fax:503-253-7286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR56671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice