Organization
WALNUT CREEK-DANVILLE ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI MATULOVICH (OFFICE MANAGER)
(925) 934-5565
Entity
Organization
Contact information
Practice address
1855 SAN MIGUEL DR, SUITE 25, WALNUT CREEK, CA 94596-5279
(925) 934-5565
(925) 934-6003
Mailing address
1855 SAN MIGUEL DR, SUITE 25, WALNUT CREEK, CA 94596-5279
(925) 934-5565
(925) 934-6003
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
30346
CA
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
37490
CA
Other
Enumeration date
01/20/2011
Last updated
01/29/2018
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