Healthcare Provider Details

I. General information

NPI: 1235454992
Provider Name (Legal Business Name): JESSIE ELIZABETH HOFFMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE ELIZABETH MCQUISTON DMD

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20440 ROUTE 19
CRANBERRY TOWNSHIP PA
16066-7543
US

IV. Provider business mailing address

9782 BRANT AVE
PITTSBURGH PA
15237-4342
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-9688
  • Fax: 724-772-9695
Mailing address:
  • Phone: 412-780-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039065
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: