Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | TBD | AZ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3916 | WV |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DD446 | NM |
N | 204E00000X | Oral & Maxillofacial Surgeon | TBD | AZ |
NPI | 1356570824 |
---|---|
Provider Name | Matthew Clifton Hanchett |
First Address | Paradise Valley, AZ 85253-2832 |
Second Address | Gilbert, AZ 85295-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2009 |
Last Update Date | 02/07/2020 |