Healthcare Provider Details

I. General information

NPI: 1508871260
Provider Name (Legal Business Name): TIMOTHY JAY HOFTIEZER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 GREYHOUND PASS SUITE B
CARMEL IN
46032-5027
US

IV. Provider business mailing address

1610 GREYHOUND PASS SUITE B
CARMEL IN
46032-5027
US

V. Phone/Fax

Practice location:
  • Phone: 317-705-5800
  • Fax: 317-705-1958
Mailing address:
  • Phone: 317-705-5800
  • Fax: 317-705-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009970
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: