Provider Demographics
NPI:1417037011
Name:HANHILA, MATT OSCAR III (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:OSCAR
Last Name:HANHILA
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 E MISSOURI AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2446
Mailing Address - Country:US
Mailing Address - Phone:602-279-2981
Mailing Address - Fax:602-279-1074
Practice Address - Street 1:1515 E MISSOURI AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2446
Practice Address - Country:US
Practice Address - Phone:602-279-2981
Practice Address - Fax:602-279-1074
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice