Provider Demographics
NPI:1720100571
Name:MATA, DUANE RODGERS-PEREZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:RODGERS-PEREZ
Last Name:MATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7150 E HAMPDEN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3026
Mailing Address - Country:US
Mailing Address - Phone:303-758-9511
Mailing Address - Fax:303-758-3834
Practice Address - Street 1:1194 W ASH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4651
Practice Address - Country:US
Practice Address - Phone:970-686-7775
Practice Address - Fax:970-686-5892
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO82911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice