Provider Demographics
NPI:1982438099
Name:MATTSON, BRIAN RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:MATTSON
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 1:19435 AVENIDA PRESA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-7441
Mailing Address - Country:US
Mailing Address - Phone:951-387-0009
Mailing Address - Fax:951-387-0009
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD STE A110
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9101
Practice Address - Country:US
Practice Address - Phone:951-461-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist