Provider Demographics
NPI:1982124954
Name:HOFRICHTER, MATTHEW CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARL
Last Name:HOFRICHTER
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:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0092
Mailing Address - Country:US
Mailing Address - Phone:631-872-0758
Mailing Address - Fax:
Practice Address - Street 1:3716 MELROSE AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2716
Practice Address - Country:US
Practice Address - Phone:540-362-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice