Individual
DR. JEREMY ISAK MATIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
92D MEDICAL GROUP, 701 HOSPITAL LOOP, SUITE 350, FAIRCHILD AFB, WA 99011
(095) 247-4770
Mailing address
92D MEDICAL GROUP, 701 HOSPITAL LOOP, SUITE 350, FAIRCHILD AFB, WA 99011
(509) 247-4770
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011813A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/07/2012
Last updated
06/25/2024
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