Healthcare Provider Details

I. General information

NPI: 1588225825
Provider Name (Legal Business Name): JORDAN THOMAS HOFFER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VIOLET RD STE 1
CRITTENDEN KY
41030-8948
US

IV. Provider business mailing address

18 GEORGETOWN DR
FORT MITCHELL KY
41017-2858
US

V. Phone/Fax

Practice location:
  • Phone: 859-428-3100
  • Fax:
Mailing address:
  • Phone: 859-609-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10328
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: