Healthcare Provider Details

I. General information

NPI: 1790003812
Provider Name (Legal Business Name): DAVID HOFFMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0292
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-0292
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6101
  • Fax: 859-323-5858
Mailing address:
  • Phone: 859-323-6101
  • Fax: 859-323-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: