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General NPI Number Information
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NPI Number | 1841409489
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Entity Type | Organization
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Legal Business Name | FREDERICK L. HOFFER, A PROFESSIONAL DENTAL CORP.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 503 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4611
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Country | US
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Telephone | 909-793-7884
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Fax | 909-335-1528
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Provider Business Mailing Address
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Address Line | 503 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4611
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Country | US
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Telephone | 909-793-7884
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Fax | 909-335-1528
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MICHELLE ANNE SMITH
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Credential |
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Telephone | 909-793-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43970
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License Number State | CA
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