Healthcare Provider Details

I. General information

NPI: 1962561381
Provider Name (Legal Business Name): JACK HOEFFLEUR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/10/2012
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 Number
License Number State

VIII. Authorized Official

Name: DR. JACQUES HOEFFLEUR
Title or Position: PRESIDENT
Credential: DDS
Phone: 262-968-9191