Provider Demographics
NPI:1265216881
Name:MATTHEW HEARN LTD
Entity type:Organization
Organization Name:MATTHEW HEARN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:504-220-7344
Mailing Address - Street 1:3712 LAKE HURON DR APT 104
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6746
Mailing Address - Country:US
Mailing Address - Phone:504-220-7344
Mailing Address - Fax:
Practice Address - Street 1:3204 LANCER ST STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4491
Practice Address - Country:US
Practice Address - Phone:219-762-1806
Practice Address - Fax:219-763-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty