Healthcare Provider Details

I. General information

NPI: 1821480815
Provider Name (Legal Business Name): FREDERICK HOFFER III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 BROOKSIDE AVE
REDLANDS CA
92373-4611
US

IV. Provider business mailing address

503 BROOKSIDE AVE
REDLANDS CA
92373-4611
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-7884
  • Fax:
Mailing address:
  • Phone: 909-793-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: