Healthcare Provider Details

I. General information

NPI: 1518275460
Provider Name (Legal Business Name): JEREMY MICHAEL HOFF D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN SUITE 203
REDLANDS CA
92374-0111
US

IV. Provider business mailing address

1895 ORANGE TREE LN SUITE 203
REDLANDS CA
92374-0111
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-5353
  • Fax: 909-307-5388
Mailing address:
  • Phone: 909-307-5353
  • Fax: 909-307-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: