Healthcare Provider Details

I. General information

NPI: 1770620916
Provider Name (Legal Business Name): CORY MICHAEL HOFFMAN D.D.S., C.A.G.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 OLD CONEJO RD
NEWBURY PARK CA
91320-2152
US

IV. Provider business mailing address

3265 OLD CONEJO RD
NEWBURY PARK CA
91320-2152
US

V. Phone/Fax

Practice location:
  • Phone: 805-480-1999
  • Fax: 805-480-1911
Mailing address:
  • Phone: 805-480-1999
  • Fax: 805-480-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number53910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: