Healthcare Provider Details

I. General information

NPI: 1972687598
Provider Name (Legal Business Name): CHARLES HOWARD HOFFMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GLEN ST SUITE 303
GLEN COVE NY
11542-2782
US

IV. Provider business mailing address

15 GLEN ST SUITE 303
GLEN COVE NY
11542-2782
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-9400
  • Fax:
Mailing address:
  • Phone: 516-674-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number043445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: