Provider Demographics
NPI:1912117540
Name:MATSUNAGA, CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:MATSUNAGA
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 1:1402 MARIA LANE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5313
Mailing Address - Country:US
Mailing Address - Phone:925-934-1777
Mailing Address - Fax:925-934-9131
Practice Address - Street 1:1402 MARIA LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5313
Practice Address - Country:US
Practice Address - Phone:925-934-4777
Practice Address - Fax:925-934-9131
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41836586OtherCA TAX ID