Healthcare Provider Details

I. General information

NPI: 1477546943
Provider Name (Legal Business Name): HOLLY VAN HOFWEGEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 S CLIFF AVE
SIOUX FALLS SD
57108
US

IV. Provider business mailing address

5120 S CLIFF AVE
SIOUX FALLS SD
57108
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-2607
  • Fax:
Mailing address:
  • Phone: 605-334-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411084
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: