Provider Demographics
NPI:1457543472
Name:MATIN, GULALAI
Entity type:Individual
Prefix:DR
First Name:GULALAI
Middle Name:
Last Name:MATIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GULALAI
Other - Middle Name:
Other - Last Name:MATIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4645 FRAZEE RD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6152
Mailing Address - Country:US
Mailing Address - Phone:760-722-0137
Mailing Address - Fax:760-722-8696
Practice Address - Street 1:4645 FRAZEE RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6152
Practice Address - Country:US
Practice Address - Phone:760-722-0137
Practice Address - Fax:760-722-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43199122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist