Provider Demographics
NPI:1215152848
Name:MATSUI, THOMAS KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENNETH
Last Name:MATSUI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 COLE BLVD
Mailing Address - Street 2:#120
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3410
Mailing Address - Country:US
Mailing Address - Phone:303-234-0505
Mailing Address - Fax:303-234-0226
Practice Address - Street 1:1526 COLE BLVD
Practice Address - Street 2:#120
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3410
Practice Address - Country:US
Practice Address - Phone:303-234-0505
Practice Address - Fax:303-234-0226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist