Provider Demographics
NPI:1275796203
Name:HART, MATTHEW STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:HART
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 1:1703 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3517
Mailing Address - Country:US
Mailing Address - Phone:931-381-5282
Mailing Address - Fax:931-381-5298
Practice Address - Street 1:1703 GROVE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3517
Practice Address - Country:US
Practice Address - Phone:931-381-5282
Practice Address - Fax:931-381-5298
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN8844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist