Provider Demographics
NPI:1972687598
Name:HOFFMAN, CHARLES HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:HOFFMAN
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 1:15 GLEN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2782
Mailing Address - Country:US
Mailing Address - Phone:516-674-9400
Mailing Address - Fax:
Practice Address - Street 1:15 GLEN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2782
Practice Address - Country:US
Practice Address - Phone:516-674-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0434451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery