Provider Demographics
NPI:1851382170
Name:HOEFS, MICHAEL DEAN (DDS, FADI)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:HOEFS
Suffix:
Gender:M
Credentials:DDS, FADI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 CHAMPLAIN DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4714
Mailing Address - Country:US
Mailing Address - Phone:402-477-5665
Mailing Address - Fax:402-477-1478
Practice Address - Street 1:4640 CHAMPLAIN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4714
Practice Address - Country:US
Practice Address - Phone:402-477-5665
Practice Address - Fax:402-477-1478
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064546300Medicaid
NE47064546300Medicaid
NE278924Medicare ID - Type UnspecifiedMEDICARE PERFORMING PROVI