Healthcare Provider Details

I. General information

NPI: 1730221375
Provider Name (Legal Business Name): STUART J. HOFFMAN D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 PARK GRANADA SUITE 104
CALABASAS CA
91302-1545
US

IV. Provider business mailing address

4764 PARK GRANADA SUITE 104
CALABASAS CA
91302-1545
US

V. Phone/Fax

Practice location:
  • Phone: 818-222-0090
  • Fax: 818-222-5728
Mailing address:
  • Phone: 818-222-0090
  • Fax: 818-222-5728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number39011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: