Provider Demographics
NPI:1265550768
Name:MATHILDE HOUSER, D.D.S.
Entity type:Organization
Organization Name:MATHILDE HOUSER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHILDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-349-0748
Mailing Address - Street 1:620 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5035
Mailing Address - Country:US
Mailing Address - Phone:805-349-0748
Mailing Address - Fax:805-346-1535
Practice Address - Street 1:620 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5035
Practice Address - Country:US
Practice Address - Phone:805-349-0748
Practice Address - Fax:805-346-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty