Provider Demographics
NPI:1811216898
Name:GAYHEART, MATTHEW NATHANIEL (DMD , MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NATHANIEL
Last Name:GAYHEART
Suffix:
Gender:M
Credentials:DMD , MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 GLENGARTH PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8556
Mailing Address - Country:US
Mailing Address - Phone:859-661-0106
Mailing Address - Fax:
Practice Address - Street 1:216 FOUNTAIN CT STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2181
Practice Address - Country:US
Practice Address - Phone:859-264-1898
Practice Address - Fax:859-685-0118
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY991OtherOMS SPECIALTY LICENSE
KY7100186190Medicaid