MEDICARE: DR. ROBERT BARKER HOFFMAN D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1487690731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BARKER HOFFMAN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	521 DEVONSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7564
Country	:	US
Telephone Number	:	815-459-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 DEVONSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7564
Country	:	US
Telephone Number	:	815-459-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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