Healthcare Provider Details

I. General information

NPI: 1891147187
Provider Name (Legal Business Name): ANJA M HOFFSTROM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANJA M KOSKI

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 06/18/2023
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 STATE HIGHWAY M553
MARQUETTE MI
49855-9422
US

IV. Provider business mailing address

304 STATE HIGHWAY M553
MARQUETTE MI
49855-9422
US

V. Phone/Fax

Practice location:
  • Phone: 906-242-2443
  • Fax:
Mailing address:
  • Phone: 906-242-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021945
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: