Provider Demographics
NPI:1730584707
Name:HOFFMAN FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:HOFFMAN FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-297-1675
Mailing Address - Street 1:6932 WILLIAMS RD
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-297-1675
Mailing Address - Fax:716-297-1676
Practice Address - Street 1:6932 WILLIAMS RD
Practice Address - Street 2:SUITE 1900
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-297-1675
Practice Address - Fax:716-297-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03308409Medicaid