Provider Demographics
NPI:1033978523
Name:DANIEL A MATATIAHO DDS INC
Entity type:Organization
Organization Name:DANIEL A MATATIAHO DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MATATIAHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-654-1100
Mailing Address - Street 1:8205 SANTA MONICA BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:W HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5963
Mailing Address - Country:US
Mailing Address - Phone:323-654-1100
Mailing Address - Fax:
Practice Address - Street 1:8205 SANTA MONICA BLVD STE 12
Practice Address - Street 2:
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5963
Practice Address - Country:US
Practice Address - Phone:323-654-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental