Provider Demographics
NPI:1841473493
Name:HOXIE, BRENT JENNINGS (DDS)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JENNINGS
Last Name:HOXIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALIFORNIA MEN'S COLONY
Mailing Address - Street 2:HWY 1
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93409-0001
Mailing Address - Country:US
Mailing Address - Phone:805-547-7857
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA MEN'S COLONY
Practice Address - Street 2:HWY 1
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93409-0001
Practice Address - Country:US
Practice Address - Phone:805-547-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist