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General NPI Number Information
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NPI Number | 1083128342
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Entity Type | Organization
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Legal Business Name | MATTHEW A HOSTETLER DDS SC
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Dates
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Enumeration Date | 11/24/2017
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Last Update Date | 11/24/2017
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Provider Practice Location Address
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Address Line | 161 HORIZON DR STE 103C
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City | VERONA
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State | WI
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Zip | 53593-1250
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Country | US
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Telephone | 260-845-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 453 CHERRY HILL DR
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City | MADISON
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State | WI
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Zip | 53717-2654
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Country | US
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Telephone | 260-402-5616
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MATTHEW ALAN HOSTETLER
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Credential | DDS
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Telephone | 260-402-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1769-15
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License Number State | WI
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