Provider Demographics
NPI:1174506000
Name:HAYDEN, MATTHEW J (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W ELM AVE
Mailing Address - Street 2:SUITE #240
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2700
Mailing Address - Country:US
Mailing Address - Phone:541-567-8414
Mailing Address - Fax:541-567-8422
Practice Address - Street 1:1050 W ELM AVE
Practice Address - Street 2:SUITE #240
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2700
Practice Address - Country:US
Practice Address - Phone:541-567-8414
Practice Address - Fax:541-567-8422
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067285Medicaid