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General NPI Number Information
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NPI Number | 1972641561
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Entity Type | Organization
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Legal Business Name | J. MATTHEW HOGENDOBLER, D.M.D.
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1729 WILDWOOD DR STE 104 LINKHORN POINT PROFESSIONAL CENTER
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3176
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Country | US
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Telephone | 757-481-5454
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Fax | 757-481-9236
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Provider Business Mailing Address
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Address Line | 2209 N LAKESIDE DR EASTWOOD MANOR HOUSE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2017
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Country | US
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Telephone | 757-481-7811
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Fax | 757-481-1105
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Authorized Official
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Title or Position | OWNER
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Name | DR. J. MATTHEW HOGENDOBLER
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Credential | B.S., D.M.D.
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Telephone | 757-481-7811
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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 | 0401007115
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License Number State | VA
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