Provider Demographics
NPI:1033310834
Name:HOEG, CHARLES RICHARD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:HOEG
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:R
Other - Last Name:HOEG DMD PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:45 ROUTE 25A
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1389
Mailing Address - Country:US
Mailing Address - Phone:631-744-2288
Mailing Address - Fax:631-744-2651
Practice Address - Street 1:45 ROUTE 25A
Practice Address - Street 2:SUITE A1
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1389
Practice Address - Country:US
Practice Address - Phone:631-744-2288
Practice Address - Fax:631-744-2651
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist