Provider Demographics
NPI:1073945788
Name:HOAG, JUSTIN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:HOAG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 WEST 6TH ST.
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY ATTN: NANCY POSEY-EDWARDS
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-4704
Mailing Address - Country:US
Mailing Address - Phone:912-767-6735
Mailing Address - Fax:
Practice Address - Street 1:477 VIKING DR STE 190US
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7349
Practice Address - Country:US
Practice Address - Phone:757-486-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist