Provider Demographics
NPI:1285933200
Name:MATA, ANNETTE F (DDS, MPH)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:F
Last Name:MATA
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:F
Other - Last Name:MATA-MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MPH
Mailing Address - Street 1:5270 N O CONNOR BLVD APT 1207
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5717
Mailing Address - Country:US
Mailing Address - Phone:281-935-6072
Mailing Address - Fax:
Practice Address - Street 1:4624 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4027
Practice Address - Country:US
Practice Address - Phone:972-840-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000000OtherNONE