Healthcare Provider Details

I. General information

NPI: 1649648387
Provider Name (Legal Business Name): JOHN HOFER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 WHITMAN WAY APT 306
CARLSBAD CA
92008-4635
US

IV. Provider business mailing address

5102 WHITMAN WAY APT 306
CARLSBAD CA
92008-4635
US

V. Phone/Fax

Practice location:
  • Phone: 608-332-7938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13601
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: