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General NPI Number Information
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NPI Number | 1699380246
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Entity Type | Organization
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Legal Business Name | CHARLES R HOEG DMD PC
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 45 ROUTE 25A STE A1
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City | SHOREHAM
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State | NY
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Zip | 11786-1389
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Country | US
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Telephone | 631-241-6405
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Fax | 631-744-2651
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Provider Business Mailing Address
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Address Line | 2519 WELLSPRING ST
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City | CARLSBAD
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State | CA
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Zip | 92010-5604
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Country | US
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Telephone | 631-241-6405
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. CHARLES RICHARD HOEG
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Credential | DMD
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Telephone | 631-241-6405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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