Provider Demographics
NPI:1093815706
Name:HOFMANN, STEVEN RICHARD (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:HOFMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-3035
Mailing Address - Country:US
Mailing Address - Phone:623-849-0053
Mailing Address - Fax:
Practice Address - Street 1:7614 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3035
Practice Address - Country:US
Practice Address - Phone:623-849-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7249122300000X
TX25162122300000X
NC9075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist