Healthcare Provider Details

I. General information

NPI: 1003264508
Provider Name (Legal Business Name): JAMESON EVERETT HOFFMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PANZER KASERNE BLDG 2996
APO AE
09046
US

IV. Provider business mailing address

PANZER KASERNE BLDG 2996
APO AE
09046
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1664
  • Fax: 314-590-2881
Mailing address:
  • Phone: 314-590-1664
  • Fax: 314-590-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9790047-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9790047-9921
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9790047-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: