Basic Information
| Provider Information | |||||||||
| NPI: | 1982124954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFRICHTER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 92 | ||||||||
| Address2: | |||||||||
| City: | GREAT RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117390092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318720758 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3716 MELROSE AVE NW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240172716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403620360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401415676 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.