Provider Demographics
NPI:1427385483
Name:HOHM, GOTTFRIED (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOTTFRIED
Middle Name:
Last Name:HOHM
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:N50W34770 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKAUCHEE
Mailing Address - State:WI
Mailing Address - Zip Code:53069-9750
Mailing Address - Country:US
Mailing Address - Phone:262-567-0770
Mailing Address - Fax:262-567-0851
Practice Address - Street 1:N50W34770 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OKAUCHEE
Practice Address - State:WI
Practice Address - Zip Code:53069-9750
Practice Address - Country:US
Practice Address - Phone:262-567-0770
Practice Address - Fax:262-567-0851
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3213-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist