Healthcare Provider Details

I. General information

NPI: 1003052275
Provider Name (Legal Business Name): HOFFMAN ORTHODONTICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 DEVONSHIRE LN
CRYSTAL LAKE IL
60014-7564
US

IV. Provider business mailing address

521 DEVONSHIRE LN
CRYSTAL LAKE IL
60014-7564
US

V. Phone/Fax

Practice location:
  • Phone: 815-459-3434
  • Fax: 815-459-3498
Mailing address:
  • Phone: 815-459-3434
  • Fax: 815-459-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019-025088
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT BARKER HOFFMAN
Title or Position: DOCTOR
Credential: DDS MS
Phone: 815-459-3434