Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 35643 | CA |
NPI | 1003095951 |
---|---|
Provider Name | Dr. Bita Louise Matin |
First Address | Concord, CA 94521 |
Second Address | Concord, CA 94521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 29/10/2007 |