Healthcare Provider Details

I. General information

NPI: 1902355456
Provider Name (Legal Business Name): JORDAN ROGER HOBEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 LIVE OAK DR
LITTLE RIVER SC
29566-9138
US

IV. Provider business mailing address

PO BOX 547
LITTLE RIVER SC
29566-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8013
  • Fax: 843-663-8166
Mailing address:
  • Phone: 843-663-8013
  • Fax: 843-663-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16158
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: