Provider Demographics
NPI:1437138534
Name:HOFFMAN, PETER JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
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 1:237 W HICKORY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1457
Mailing Address - Country:US
Mailing Address - Phone:843-228-5577
Mailing Address - Fax:843-228-5196
Practice Address - Street 1:1 PINCKNEY BLVD
Practice Address - Street 2:ATTN: PROFESSIONAL AFFIARS COORDINATOR
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6148
Practice Address - Country:US
Practice Address - Phone:843-228-5577
Practice Address - Fax:843-228-5196
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000OTHMedicare UPIN