Individual
DR. LAURIE MATIASEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2101 COURAGE DR, FAIRFIELD, CA 94533
(707) 784-2120
(707) 784-2126
Mailing address
5139 LEONARDO CT., FAIRFIELD, CA 94534
(707) 784-2120
(707) 784-2126
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
D23013
CA
Other
Enumeration date
10/18/2006
Last updated
07/08/2007
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