Healthcare Provider Details

I. General information

NPI: 1619049905
Provider Name (Legal Business Name): LARRY I HOFFMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6258 N LINCOLN AVE
CHICAGO IL
60659-2235
US

IV. Provider business mailing address

6258 N LINCOLN AVE
CHICAGO IL
60659-2235
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-5520
  • Fax: 773-478-1319
Mailing address:
  • Phone: 773-478-5520
  • Fax: 773-478-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19013365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: