Individual
DR. MATTHEW WILLIAM HEARN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
2005 ROOSEVELT RD, SUITE B, VALPARAISO, IN 46383-2746
(219) 531-9293
Mailing address
3712 LAKE HURON DR APT 104, VALPARAISO, IN 46383-6746
(504) 220-7344
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
01060238A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
01060238E
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200511950
—
IN
Enumeration date
09/08/2006
Last updated
12/16/2021
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