Provider Demographics
NPI:1043224652
Name:HOFFMAN, ROBERT ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROY
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3246
Mailing Address - Country:US
Mailing Address - Phone:313-271-5555
Mailing Address - Fax:313-271-5555
Practice Address - Street 1:19600 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3246
Practice Address - Country:US
Practice Address - Phone:313-271-5555
Practice Address - Fax:313-271-5555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010136091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1503891Medicaid