Healthcare Provider Details

I. General information

NPI: 1083034060
Provider Name (Legal Business Name): JACQUES HOEFFLEUR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACK HOEFFLEUR D.D.S.

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N WALES RD
WALES WI
53183-9735
US

IV. Provider business mailing address

225 N WALES RD
WALES WI
53183-9735
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-9191
  • Fax:
Mailing address:
  • Phone: 262-968-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3189-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: