Provider Demographics
NPI:1578872685
Name:MINNESOTA ORAL & MAXILLOFACIAL SURGERY, P.A.
Entity Type:Organization
Organization Name:MINNESOTA ORAL & MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-925-2525
Mailing Address - Street 1:15655 37TH AVE. N.
Mailing Address - Street 2:280
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4000
Mailing Address - Country:US
Mailing Address - Phone:763-520-1234
Mailing Address - Fax:763-520-1233
Practice Address - Street 1:15655 37TH AVE. N.
Practice Address - Street 2:280
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4000
Practice Address - Country:US
Practice Address - Phone:763-520-1234
Practice Address - Fax:763-520-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty