Provider Demographics
NPI:1164605259
Name:HOIDAL, MATT JAMES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:JAMES
Last Name:HOIDAL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 OSWEGO POINTE DR
Mailing Address - Street 2:STE 106
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3254
Mailing Address - Country:US
Mailing Address - Phone:503-635-3584
Mailing Address - Fax:503-635-6813
Practice Address - Street 1:300 OSWEGO POINTE DR
Practice Address - Street 2:STE 106
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3254
Practice Address - Country:US
Practice Address - Phone:503-635-3584
Practice Address - Fax:503-635-6813
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD90751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics