Healthcare Provider Details

I. General information

NPI: 1326255597
Provider Name (Legal Business Name): EDWARD W. HOFFMANN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 W NORTH AVE
BROOKFIELD WI
53005-4637
US

IV. Provider business mailing address

12720 W NORTH AVE
BROOKFIELD WI
53005-4637
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-4026
  • Fax: 262-784-2772
Mailing address:
  • Phone: 262-784-4026
  • Fax: 262-784-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2272
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: