Provider Demographics
NPI:1770787285
Name:MATOSSIAN, KIRK (DDS)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:MATOSSIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6333
Mailing Address - Country:US
Mailing Address - Phone:626-796-1622
Mailing Address - Fax:626-796-2759
Practice Address - Street 1:1245 W HUNTINGTON DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6333
Practice Address - Country:US
Practice Address - Phone:626-796-1622
Practice Address - Fax:626-796-2759
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist