Healthcare Provider Details

I. General information

NPI: 1669692091
Provider Name (Legal Business Name): KIRK MATTHEW HOBOCK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32382 DEL OBISPO ST SUITE C-2
SAN JUAN CAPISTRANO CA
92675-4029
US

IV. Provider business mailing address

32382 DEL OBISPO ST SUITE C-2
SAN JUAN CAPISTRANO CA
92675-4029
US

V. Phone/Fax

Practice location:
  • Phone: 949-493-6006
  • Fax: 949-493-6764
Mailing address:
  • Phone: 949-493-6006
  • Fax: 949-493-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: