Provider Demographics
NPI:1821661042
Name:HAYASE, MATTHEW JUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JUSTIN
Last Name:HAYASE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:JUSTIN
Other - Last Name:HAYASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11572 C STREET
Mailing Address - Street 2:
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433
Mailing Address - Country:US
Mailing Address - Phone:253-967-4615
Mailing Address - Fax:
Practice Address - Street 1:11572 C STREET
Practice Address - Street 2:
Practice Address - City:FORT LEWIS
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-967-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist