Healthcare Provider Details

I. General information

NPI: 1558358176
Provider Name (Legal Business Name): MICHAEL J HOFFMANN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 FRANCIS PL SUITE 305
SAINT LOUIS MO
63105-2465
US

IV. Provider business mailing address

950 FRANCIS PL SUITE 305
SAINT LOUIS MO
63105-2465
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-7844
  • Fax: 314-862-4504
Mailing address:
  • Phone: 314-862-7844
  • Fax: 314-862-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number015074
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: