Provider Demographics
NPI:1356570824
Name:HANCHETT, MATTHEW CLIFTON (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CLIFTON
Last Name:HANCHETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 E LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2832
Mailing Address - Country:US
Mailing Address - Phone:205-837-4674
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR STE 164
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1638
Practice Address - Country:US
Practice Address - Phone:205-837-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39161223S0112X
NMDD4461223S0112X
AZTBD204E00000X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty