Healthcare Provider Details

I. General information

NPI: 1982124954
Provider Name (Legal Business Name): MATTHEW CARL HOFRICHTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 MELROSE AVE NW
ROANOKE VA
24017-2716
US

IV. Provider business mailing address

PO BOX 92
GREAT RIVER NY
11739-0092
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-0360
  • Fax:
Mailing address:
  • Phone: 631-872-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415676
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: