Individual
DR. CHARLES ALBERT MATTISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
933 CENTINELA AVE, INGLEWOOD, CA 90302-1501
(310) 677-4085
(310) 677-1357
Mailing address
933 CENTINELA AVE, INGLEWOOD, CA 90302-1501
(310) 677-4085
(310) 677-1357
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
21034
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B21034 01
DENTICAL
CA
Enumeration date
03/11/2007
Last updated
07/08/2007
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