MEDICARE: DR. CORY MICHAEL HOFFMAN D.D.S., C.A.G.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	53910	CA

General Provider Information

NPI Number	:	1770620916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY MICHAEL HOFFMAN D.D.S., C.A.G.S.

Provider Business Mailing Address
First Line	:	3265 OLD CONEJO RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2152
Country	:	US
Telephone Number	:	805-480-1999
Fax Number	:	805-480-1911

Provider Business Practice Location Address
First Line	:	3265 OLD CONEJO RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2152
Country	:	US
Telephone Number	:	805-480-1999
Fax Number	:	805-480-1911

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/10/2011

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