Healthcare Provider Details

I. General information

NPI: 1043224652
Provider Name (Legal Business Name): ROBERT ROY HOFFMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 W WARREN AVE
DETROIT MI
48228-3246
US

IV. Provider business mailing address

19600 W WARREN AVE
DETROIT MI
48228-3246
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-5555
  • Fax: 313-271-5555
Mailing address:
  • Phone: 313-271-5555
  • Fax: 313-271-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901013609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: