Mark Jonathan Materum | Daly City, CA • PECOS Search

Mark Jonathan Materum

Dentist

Dental Providers

343 Gellert Blvd Ste A, Daly City, CA 94015-2620

PECOS Enrollment

Based on the most recent information from CMS, provider Mark Jonathan Materum does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1033750567
Provider Type
Individual
Full Name
Materum, Mark Jonathan
Title
Dr.
Credential
DDS

Gender
Male
Sole Proprietor
No
Enumeration Date
10/7/2019
Last Updated
10/7/2019

Contact Information

Practice Location

343 Gellert Blvd Ste A, Daly City, CA 94015-2620

Unlisted Fax

Mailing Location

343 Gellert Blvd Ste A, Daly City, CA 94015-2620

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 103450 California