Provider Demographics
NPI:1730801820
Name:HOFFMAN, SUSAN MICHELE (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5129
Mailing Address - Country:US
Mailing Address - Phone:619-301-9928
Mailing Address - Fax:
Practice Address - Street 1:3035 BANCROFT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-5129
Practice Address - Country:US
Practice Address - Phone:619-301-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA927124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist