Provider Demographics
NPI:1104071794
Name:MATTSSON, ELIZABETH DOMINIQUE (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DOMINIQUE
Last Name:MATTSSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 E. SONTERRA BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-349-3715
Mailing Address - Fax:210-545-2008
Practice Address - Street 1:1202 E. SONTERRA BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-349-3715
Practice Address - Fax:210-545-2008
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice