Provider Demographics
NPI:1447475363
Name:HOEY, MICHAEL F
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:HOEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-545-4625
Mailing Address - Fax:707-545-4940
Practice Address - Street 1:1174 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-545-4625
Practice Address - Fax:707-545-4940
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD19628Medicaid
CAD19628Medicaid
DS0196280Medicare ID - Type Unspecified