Provider Demographics
NPI:1528329281
Name:HARDEN, MATTHEW T (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:HARDEN
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 1:1916 N BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1902
Mailing Address - Country:US
Mailing Address - Phone:660-666-1901
Mailing Address - Fax:660-665-1903
Practice Address - Street 1:1916 N BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1902
Practice Address - Country:US
Practice Address - Phone:660-666-1901
Practice Address - Fax:660-665-1903
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist