Provider Demographics
NPI:1598177784
Name:HOFTO, LAURA REBECCA (DMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:REBECCA
Last Name:HOFTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SCUFFLETOWN RD STE E
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7296
Mailing Address - Country:US
Mailing Address - Phone:864-808-2280
Mailing Address - Fax:
Practice Address - Street 1:216 SCUFFLETOWN RD STE E
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7296
Practice Address - Country:US
Practice Address - Phone:864-808-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95321223G0001X, 1223P0221X
TN100071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015189Medicaid