Provider Demographics
NPI:1194782375
Name:MATLOFF, IRA ROBERT (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:ROBERT
Last Name:MATLOFF
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:DR
Other - First Name:I.
Other - Middle Name:ROBERT
Other - Last Name:MATLOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:4910 N 44TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2730
Mailing Address - Country:US
Mailing Address - Phone:602-840-3636
Mailing Address - Fax:602-840-7403
Practice Address - Street 1:4910 N 44TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2730
Practice Address - Country:US
Practice Address - Phone:602-840-3636
Practice Address - Fax:602-840-7403
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD23861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics