MEDICARE: DR. PETER HOFFMANN D.M.D.

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	122300000X	Dentist	19960-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	043202	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1013912815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER HOFFMANN D.M.D.

Provider Business Mailing Address
First Line	:	211 MARKET ST
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2305
Country	:	US
Telephone Number	:	814-726-3630
Fax Number	:	814-726-9887

Provider Business Practice Location Address
First Line	:	211 MARKET ST
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2305
Country	:	US
Telephone Number	:	814-726-3630
Fax Number	:	814-726-9887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/03/2010

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