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

Table of Contents

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)





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