Individual
DIANA MATATOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5311 E BROADWAY BLVD, TUCSON, AZ 85711-3710
(520) 468-6836
Mailing address
1844 W BUTLER DR, PHOENIX, AZ 85021-5264
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
33328
TX
1223G0001X
General Practice Dentistry
Primary
D009933
AZ
Other
Enumeration date
07/21/2017
Last updated
03/07/2018
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