Provider Demographics
NPI:1043218456
Name:HOFBAUER, ANN MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:HOFBAUER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5444
Mailing Address - Country:US
Mailing Address - Phone:503-474-9888
Mailing Address - Fax:503-474-9889
Practice Address - Street 1:2260 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5444
Practice Address - Country:US
Practice Address - Phone:503-474-9888
Practice Address - Fax:503-474-9889
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2015-03-03
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
ORD77101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics