Provider Demographics
NPI:1396231353
Name:VIAL, MATTHEW ALEXANDER MARIO (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALEXANDER MARIO
Last Name:VIAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 CRIMSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7306
Mailing Address - Country:US
Mailing Address - Phone:775-560-3067
Mailing Address - Fax:
Practice Address - Street 1:601 W MOANA LN STE 7
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4959
Practice Address - Country:US
Practice Address - Phone:775-825-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV70961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice