Healthcare Provider Details

I. General information

NPI: 1356570824
Provider Name (Legal Business Name): MATTHEW CLIFTON HANCHETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 164
GILBERT AZ
85295-1638
US

IV. Provider business mailing address

4525 E LAKESIDE LN
PARADISE VALLEY AZ
85253-2832
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-4674
  • Fax:
Mailing address:
  • Phone: 205-837-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3916
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD446
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberTBD
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberTBD
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: