Healthcare Provider Details

I. General information

NPI: 1013912815
Provider Name (Legal Business Name): PETER HOFFMANN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MARKET ST
WARREN PA
16365-2305
US

IV. Provider business mailing address

211 MARKET ST
WARREN PA
16365-2305
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-3630
  • Fax: 814-726-9887
Mailing address:
  • Phone: 814-726-3630
  • Fax: 814-726-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19960-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: