Provider Demographics
NPI:1497829444
Name:HOFER, MICHELLE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:HOFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 ISLAND DR.
Mailing Address - Street 2:
Mailing Address - City:FT. PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-7305
Mailing Address - Country:US
Mailing Address - Phone:605-223-2021
Mailing Address - Fax:605-223-9021
Practice Address - Street 1:304 ISLAND DR.
Practice Address - Street 2:
Practice Address - City:FT. PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57532-7305
Practice Address - Country:US
Practice Address - Phone:605-223-2021
Practice Address - Fax:605-223-9021
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD06061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice