Provider Demographics
NPI:1003052275
Name:HOFFMAN ORTHODONTICS LTD
Entity Type:Organization
Organization Name:HOFFMAN ORTHODONTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BARKER
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:815-459-3434
Mailing Address - Street 1:521 DEVONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7564
Mailing Address - Country:US
Mailing Address - Phone:815-459-3434
Mailing Address - Fax:815-459-3498
Practice Address - Street 1:521 DEVONSHIRE LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7564
Practice Address - Country:US
Practice Address - Phone:815-459-3434
Practice Address - Fax:815-459-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0250881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty