Provider Demographics
NPI:1750608782
Name:HANNA, MATTHEW ALFRED (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALFRED
Last Name:HANNA
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 1:80 MAPLE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3520
Mailing Address - Country:US
Mailing Address - Phone:631-724-3837
Mailing Address - Fax:631-863-0399
Practice Address - Street 1:80 MAPLE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3520
Practice Address - Country:US
Practice Address - Phone:631-724-3837
Practice Address - Fax:631-863-0399
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0557851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice