Healthcare Provider Details

I. General information

NPI: 1902966658
Provider Name (Legal Business Name): LAWRENCE MICHAEL HOFFMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10287 CLAYTON RD SUITE 350
SAINT LOUIS MO
63124-1172
US

IV. Provider business mailing address

10287 CLAYTON RD SUITE 350
SAINT LOUIS MO
63124-1172
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-7500
  • Fax: 314-997-4440
Mailing address:
  • Phone: 314-997-7500
  • Fax: 314-997-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number012792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: