Provider Demographics
NPI:1588225825
Name:HOFFER, JORDAN THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:THOMAS
Last Name:HOFFER
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 1:18 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2858
Mailing Address - Country:US
Mailing Address - Phone:859-609-7433
Mailing Address - Fax:
Practice Address - Street 1:800 VIOLET RD STE 1
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8948
Practice Address - Country:US
Practice Address - Phone:859-428-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist