Provider Demographics
NPI:1366864589
Name:HAARMANN, MATTHEW RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:HAARMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ADMIRAL TRUST RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236
Mailing Address - Country:US
Mailing Address - Phone:618-400-0550
Mailing Address - Fax:618-400-0824
Practice Address - Street 1:240 ADMIRAL TRUST RD.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236
Practice Address - Country:US
Practice Address - Phone:618-400-0550
Practice Address - Fax:618-400-0824
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist