Provider Demographics
NPI:1457881732
Name:HACKER, MATTHEW ALEX (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEX
Last Name:HACKER
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 1:2140 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9065
Mailing Address - Country:US
Mailing Address - Phone:615-799-9964
Mailing Address - Fax:615-799-9981
Practice Address - Street 1:2140 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9065
Practice Address - Country:US
Practice Address - Phone:615-799-9964
Practice Address - Fax:615-799-9981
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10525OtherTN PROFESSIONAL LICENSE NUMBER