Provider Demographics
NPI:1841409489
Name:FREDERICK L. HOFFER, A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:FREDERICK L. HOFFER, A PROFESSIONAL DENTAL CORP.
Other - Org Name:REDLANDS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-793-7884
Mailing Address - Street 1:503 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4611
Mailing Address - Country:US
Mailing Address - Phone:909-793-7884
Mailing Address - Fax:909-335-1528
Practice Address - Street 1:503 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4611
Practice Address - Country:US
Practice Address - Phone:909-793-7884
Practice Address - Fax:909-335-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty