Provider Demographics
NPI:1831713015
Name:CHANEY, MATTHEW T (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:CHANEY
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 1:720 W 3RD AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3157
Mailing Address - Country:US
Mailing Address - Phone:419-551-1205
Mailing Address - Fax:
Practice Address - Street 1:720 W 3RD AVE APT 207
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3157
Practice Address - Country:US
Practice Address - Phone:419-551-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.004195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist