Provider Demographics
NPI:1124166616
Name:MATIAS, JOSEFINA A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:A
Last Name:MATIAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ATLANTIC AVENUE
Mailing Address - Street 2:ATLANTIC DENTAL CARE
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565
Mailing Address - Country:US
Mailing Address - Phone:925-427-7590
Mailing Address - Fax:925-427-7592
Practice Address - Street 1:156 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:925-427-7590
Practice Address - Fax:925-427-7592
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice