Provider Demographics
NPI:1366068009
Name:HOMETOWN PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:HOMETOWN PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-509-3031
Mailing Address - Street 1:301 S PLATTE CLAY WAY STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8826
Mailing Address - Country:US
Mailing Address - Phone:816-866-3994
Mailing Address - Fax:816-608-2367
Practice Address - Street 1:301 S PLATTE CLAY WAY STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8826
Practice Address - Country:US
Practice Address - Phone:816-866-3994
Practice Address - Fax:816-608-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty