Healthcare Provider Details

I. General information

NPI: 1356747927
Provider Name (Legal Business Name): HOFFMAN & UNTERBRUNNER OF MAYFAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 W LAWRENCE AVE
CHICAGO IL
60630-2510
US

IV. Provider business mailing address

4401 W LAWRENCE AVE
CHICAGO IL
60630-2510
US

V. Phone/Fax

Practice location:
  • Phone: 773-725-6086
  • Fax:
Mailing address:
  • Phone: 773-725-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028024
License Number StateIL

VIII. Authorized Official

Name: NATHAN HOFFMAN
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 773-725-6086