Provider Demographics
NPI:1720100571
Name:MATA, DUANE RODGERS-PEREZ (DDS)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:RODGERS-PEREZ
Last Name:MATA
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 1:7150 E HAMPDEN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3026
Mailing Address - Country:US
Mailing Address - Phone:303-758-9511
Mailing Address - Fax:303-758-3834
Practice Address - Street 1:660 BANNOCK ST # L
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4506
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-602-4064
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000082911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice