Provider Demographics
NPI:1831503689
Name:GULALAI MATIN D.D.S INC
Entity type:Organization
Organization Name:GULALAI MATIN D.D.S INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GULALAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-722-0137
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:760-722-2696
Practice Address - Street 1:4645 FRAZEE RD STE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULALAI MATIN D.D.S INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty