Basic Information
| Provider Information | |||||||||
| NPI: | 1003011123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATRACIA | ||||||||
| FirstName: | YOON-MI | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5003 ASPEN PINE BLVD | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430169335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109025927 | ||||||||
| FaxNumber: | 6147613398 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N HIGH ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147613361 | ||||||||
| FaxNumber: | 6147613398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 30022533 | OH | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.