MEDICARE: HOFFMAN ORTHODONTICS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019-025088	IL

General Provider Information

NPI Number	:	1003052275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOFFMAN ORTHODONTICS LTD

Provider Business Mailing Address
First Line	:	521 DEVONSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7564
Country	:	US
Telephone Number	:	815-459-3434
Fax Number	:	815-459-3498

Provider Business Practice Location Address
First Line	:	521 DEVONSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7564
Country	:	US
Telephone Number	:	815-459-3434
Fax Number	:	815-459-3498

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ROBERT BARKER HOFFMAN
Credential	:	DDS MS
Telephone Number	:	815-459-3434

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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Directions to “HOFFMAN ORTHODONTICS LTD ” Practice Location

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