Provider Demographics
NPI:1912053836
Name:MATSUMOTO, TOYO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOYO
Middle Name:
Last Name:MATSUMOTO
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 1:85 NW ALDER PL STE D
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3201
Mailing Address - Country:US
Mailing Address - Phone:425-557-8352
Mailing Address - Fax:425-557-2993
Practice Address - Street 1:3316 129TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1347
Practice Address - Country:US
Practice Address - Phone:425-557-8352
Practice Address - Fax:425-557-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000067431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics