Healthcare Provider Details

I. General information

NPI: 1275762668
Provider Name (Legal Business Name): NATHAN S HOFFMAN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 W 95TH ST
OAK LAWN IL
60453-2112
US

IV. Provider business mailing address

6735 W 95TH ST
OAK LAWN IL
60453-2112
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-0717
  • Fax:
Mailing address:
  • Phone: 708-598-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.028024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: