Provider Demographics
NPI:1538592654
Name:HAMEDANI, MATTHEW SEENA (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SEENA
Last Name:HAMEDANI
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 1:3116 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3031
Mailing Address - Country:US
Mailing Address - Phone:708-484-9011
Mailing Address - Fax:708-484-9061
Practice Address - Street 1:3116 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-484-9011
Practice Address - Fax:708-484-9061
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190296091223S0112X, 204E00000X
IL019-029609204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty