Provider Demographics
NPI:1285889808
Name:DE LA RIONDA, MATTHEW DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:DE LA RIONDA
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 1:17175 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4050
Mailing Address - Country:US
Mailing Address - Phone:818-788-3488
Mailing Address - Fax:818-788-4388
Practice Address - Street 1:17175 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4050
Practice Address - Country:US
Practice Address - Phone:818-788-3488
Practice Address - Fax:818-788-4388
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice