1972641561 NPI number — J. MATTHEW HOGENDOBLER, D.M.D.

Table of content: (NPI 1972641561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972641561 NPI number — J. MATTHEW HOGENDOBLER, D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. MATTHEW HOGENDOBLER, D.M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972641561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2209 N LAKESIDE DR
Provider Second Line Business Mailing Address:
EASTWOOD MANOR HOUSE
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-481-7811
Provider Business Mailing Address Fax Number:
757-481-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1729 WILDWOOD DR STE 104
Provider Second Line Business Practice Location Address:
LINKHORN POINT PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-481-5454
Provider Business Practice Location Address Fax Number:
757-481-9236
Provider Enumeration Date:
02/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOGENDOBLER
Authorized Official First Name:
J.
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-481-7811

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401007115 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)