Matthew Listiyo, DMD Valid NPI
Individual provider · Dentist · Ontario, CA
- NPI
- 1104472778
- Type
- Individual (Type 1)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- DDS103994 (CA)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2019-08-10
- Last updated
- 2019-09-19
Practice location
1361 E 4th St
Ontario, CA 91764-3035
(916) 420-3989