Provider Demographics
NPI:1699036996
Name:HIENER, MATTHEW DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:HIENER
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 1:124 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3108
Mailing Address - Country:US
Mailing Address - Phone:740-373-1826
Mailing Address - Fax:740-373-1825
Practice Address - Street 1:124 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3108
Practice Address - Country:US
Practice Address - Phone:740-373-1826
Practice Address - Fax:740-373-1825
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist