Healthcare Provider Details

I. General information

NPI: 1063426658
Provider Name (Legal Business Name): MICHAEL J. HOFFMANN D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
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: 314-861-7844
  • Fax: 314-862-4504
Mailing address:
  • Phone: 314-861-7844
  • Fax: 314-862-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015074
License Number StateMO

VIII. Authorized Official

Name: MRS. MARY BOMMARITO
Title or Position: PRACTICE ADM
Credential: PRACTICE ADM
Phone: 314-862-7844