MEDICARE: DENTISTRY FIRST, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1003124108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY FIRST, PC

Provider Business Mailing Address
First Line	:	5564 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5233
Country	:	US
Telephone Number	:	757-366-5084
Fax Number	:	757-366-5095

Provider Business Practice Location Address
First Line	:	5564 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5233
Country	:	US
Telephone Number	:	757-366-5084
Fax Number	:	757-366-5095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADAM M HOGAN
Credential	:	DDS
Telephone Number	:	757-366-5084

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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