Healthcare Provider Details

I. General information

NPI: 1790276392
Provider Name (Legal Business Name): STACEY HOFFMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2018
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 W INDIANTOWN RD STE 102
JUPITER FL
33458-7546
US

IV. Provider business mailing address

654 W INDIANTOWN RD STE 102
JUPITER FL
33458-7546
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-3338
  • Fax:
Mailing address:
  • Phone: 561-747-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN23782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: