Healthcare Provider Details

I. General information

NPI: 1043218456
Provider Name (Legal Business Name): ANN MARIE HOFBAUER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

2260 SW 2ND ST
MCMINNVILLE OR
97128-5444
US

IV. Provider business mailing address

2260 SW 2ND ST
MCMINNVILLE OR
97128-5444
US

V. Phone/Fax

Practice location:
  • Phone: 503-474-9888
  • Fax: 503-474-9889
Mailing address:
  • Phone: 503-474-9888
  • Fax: 503-474-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD7710
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: