1033310834 NPI number — DR. CHARLES RICHARD HOEG JR. DMD

Table of content: DR. CHARLES RICHARD HOEG JR. DMD (NPI 1033310834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033310834 NPI number — DR. CHARLES RICHARD HOEG JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOEG
Provider First Name:
CHARLES
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOEG DMD PC
Provider Other First Name:
CHARLES
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033310834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 ROUTE 25A
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
SHOREHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11786-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-744-2288
Provider Business Mailing Address Fax Number:
631-744-2651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
SHOREHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11786-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-744-2288
Provider Business Practice Location Address Fax Number:
631-744-2651
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  36767 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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