Provider Demographics
NPI:1083034060
Name:HOEFFLEUR, JACQUES (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:HOEFFLEUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:HOEFFLEUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:225 N WALES RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9735
Mailing Address - Country:US
Mailing Address - Phone:262-968-9191
Mailing Address - Fax:
Practice Address - Street 1:225 N WALES RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9735
Practice Address - Country:US
Practice Address - Phone:262-968-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3189-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice