Healthcare Provider Details

I. General information

NPI: 1497965107
Provider Name (Legal Business Name): DR. BARRY HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 CAMINO DEL AVION
GRANITE BAY CA
95746
US

IV. Provider business mailing address

P.O. BOX 254787 PROSTHODONTIC DENTAL GROUP
SACRAMENTO CA
95865
US

V. Phone/Fax

Practice location:
  • Phone: 916-394-6550
  • Fax: 916-394-6545
Mailing address:
  • Phone: 916-394-6550
  • Fax: 916-394-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number35904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: