Provider Demographics
NPI:1093894537
Name:GARY C VAN HOFWEGEN DDS PC
Entity Type:Organization
Organization Name:GARY C VAN HOFWEGEN DDS PC
Other - Org Name:VANHOFWEGEN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSENIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-4751
Mailing Address - Street 1:111 1ST AVE. SE
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346
Mailing Address - Country:US
Mailing Address - Phone:712-728-2230
Mailing Address - Fax:712-728-2230
Practice Address - Street 1:111 1ST ST SE
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1419
Practice Address - Country:US
Practice Address - Phone:712-728-2230
Practice Address - Fax:712-728-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty