Healthcare Provider Details

I. General information

NPI: 1700082641
Provider Name (Legal Business Name): MARK HOFMEISTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 NORWOOD LN
BARTLETT IL
60103-4556
US

IV. Provider business mailing address

1048 NORWOOD LN
BARTLETT IL
60103-4556
US

V. Phone/Fax

Practice location:
  • Phone: 630-830-6056
  • Fax: 630-830-6071
Mailing address:
  • Phone: 630-830-6056
  • Fax: 630-830-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: