Active NPI
George S. Matosian, DDS
- General Practice Dentistry
- La Mesa, CA
National Provider Identifier
1104167162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 24829
- Practice address
- 8851 Center Dr
Suite 301
La Mesa, CA 91942-3017 - Phone
- (619) 460-6900
- Fax
- (619) 460-6981
- NPI assigned
- Mar 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 24829 | CA | Primary |
Addresses
Primary practice location
8851 Center Dr
Suite 301
La Mesa, CA 91942-3017
Mailing address
8851 Center Dr
Suite 301
La Mesa, CA 91942-3017
Phone (619) 460-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952487357 | Other | NPI CORPORATE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24829 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420761600000",
"number": "1104167162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8851 CENTER DR",
"address_2": "SUITE 301",
"city": "LA MESA",
"state": "CA",
"postal_code": "919423017",
"telephone_number": "619-460-6900",
"fax_number": "619-460-6981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8851 CENTER DR",
"address_2": "SUITE 301",
"city": "LA MESA",
"state": "CA",
"postal_code": "919423017",
"telephone_number": "619-460-6900",
"fax_number": "619-460-6981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATOSIAN",
"first_name": "GEORGE",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-14",
"last_updated": "2015-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "24829",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI CORPORATE NUMBER",
"identifier": "1952487357",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.