Provider Demographics
NPI:1619059375
Name:HANHILA, MATT OSCAR JR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:OSCAR
Last Name:HANHILA
Suffix:JR
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:5406 W GLENN DR
Mailing Address - Street 2:5
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301
Mailing Address - Country:US
Mailing Address - Phone:623-561-1010
Mailing Address - Fax:623-435-1188
Practice Address - Street 1:5406 W GLENN DR
Practice Address - Street 2:5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301
Practice Address - Country:US
Practice Address - Phone:623-561-1010
Practice Address - Fax:623-435-1188
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ13241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics