Healthcare Provider Details

I. General information

NPI: 1700319548
Provider Name (Legal Business Name): KRISTIN HOFER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 04/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3785 STATE ROUTE 17B
CALLICOON NY
12723-5658
US

IV. Provider business mailing address

3785 STATE ROUTE 17B
CALLICOON NY
12723-5658
US

V. Phone/Fax

Practice location:
  • Phone: 845-887-4976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number024027
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number067796
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: