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General NPI Number Information
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NPI Number | 1417180498
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Entity Type | Individual
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Provider Name | MATTHEW ALAN HOSTETLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/19/2019
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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 | 608-845-7350
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Fax | 608-845-9793
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Provider Business Mailing Address
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Address Line | 6797 HORSESHOE BND
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City | VERONA
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State | WI
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Zip | 53593-9211
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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 |
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Name |
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Credential |
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Telephone |
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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 | 12011314A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901020290
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7169-15
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License Number State | WI
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