Provider Demographics
NPI:1699380246
Name:CHARLES R HOEG DMD PC
Entity Type:Organization
Organization Name:CHARLES R HOEG DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HOEG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-241-6405
Mailing Address - Street 1:2519 WELLSPRING ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5604
Mailing Address - Country:US
Mailing Address - Phone:631-241-6405
Mailing Address - Fax:
Practice Address - Street 1:45 ROUTE 25A STE A1
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1389
Practice Address - Country:US
Practice Address - Phone:631-241-6405
Practice Address - Fax:631-744-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental