Provider Demographics
NPI:1487712543
Name:MATSON, BRUCE A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:MATSON
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 1:8243 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1105
Mailing Address - Country:US
Mailing Address - Phone:713-644-7711
Mailing Address - Fax:713-644-6125
Practice Address - Street 1:8243 COLGATE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1105
Practice Address - Country:US
Practice Address - Phone:713-644-7711
Practice Address - Fax:713-644-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice