Healthcare Provider Details

I. General information

NPI: 1669887626
Provider Name (Legal Business Name): MRS. DIANE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 PLEASANT LAKE AVE
HARWICH MA
02645-1813
US

IV. Provider business mailing address

351 PLEASANT LAKE AVE
HARWICH MA
02645-1813
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH88186
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: