Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60275 | CA |
NPI | 1003100959 |
---|---|
Provider Name | Dr. John Matchett |
First Address | Burbank, CA 91506-1448 |
Second Address | Burbank, CA 91506-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 07/06/2011 |