Provider Demographics
NPI:1619947314
Name:HOFFMANN, WILLIAM PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PETER
Last Name:HOFFMANN
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 1:15655 37TH AVENUE NORTH
Mailing Address - Street 2:280
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39571Medicare UPIN
MN850000062Medicare ID - Type Unspecified
MNC01183Medicare PIN