Provider Demographics
NPI:1417180498
Name:HOSTETLER, MATTHEW ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:HOSTETLER
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 1:6797 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9211
Mailing Address - Country:US
Mailing Address - Phone:260-402-5616
Mailing Address - Fax:
Practice Address - Street 1:161 HORIZON DR STE 103C
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1250
Practice Address - Country:US
Practice Address - Phone:608-845-7350
Practice Address - Fax:608-845-9793
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011314A1223G0001X
MI29010202901223G0001X
WI7169-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice