Basic Information
| Provider Information | |||||||||
| NPI: | 1598012163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASAKI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | GEORGE KAIMI | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1077 VIA PRATO LN | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890110600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494225217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3140 S DURANGO DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891179189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023621856 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6295 | NV | Y | Dental Providers | Dentist | General Practice |
No ID Information.