Healthcare Provider Details

I. General information

NPI: 1073618849
Provider Name (Legal Business Name): GENERAL DENTISTRY OF SEYMOUR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 STATE HWY 54 STE 1
SEYMOUR WI
54165
US

IV. Provider business mailing address

344 STATE HIGHWAY 54 STE 1
SEYMOUR WI
54165
US

V. Phone/Fax

Practice location:
  • Phone: 920-833-2215
  • Fax:
Mailing address:
  • Phone: 920-833-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberW2493
License Number StateWI

VIII. Authorized Official

Name: DR. DONALD JOSEPH HOFF JR.
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 920-833-2215